[Comparative study of medullary epitheliomas in the thyroid body with and without amyloid stroma]

Fatal sporadic medullary carcinoma of the thyroid

Thirteen cases of fatal sporadic medullary carcinoma of the thyroid (MCT) that killed the patient within 1 year after diagnosis were compared with 12 nonfatal MCTs with excellent prognosis. Males predominated in fatal cases whereas the reverse was true in MCTs with good prognosis. The two groups of tumors showed generally similar cytoarchitectural features. Outstanding features of fatal MCTs, as compared with nonfatal ones, included more cellular atypia, less frequent amyloid stroma and calcification, higher mitotic rate, tumor necrosis, and a generally lower proportion of neoplastic cells stained for calcitonin. We believe that the morphological features based on routine histological studies, together with immunohistochemistry, should be reported by the pathologist since they could be useful for the management and follow-up of patients with MCT.

Chromogranin A immunoreactivity compared with argyrophilia, calcitonin immunoreactivity, and amyloid as tumour markers in the histopathological diagnosis of medullary (C-cell) thyroid carcinoma

Applying the WHO criteria for the histopathological diagnosis of medullary thyroid carcinoma (MTC)--as well as the criterion that a significant amount of argyrophil cells, amyloid deposits, or calcitonin (CT) immunoreactive cells shall be present--122 cases were identified from the files of the Swedish Cancer Registry. Both non-occult (n = 110) and "occult" (less than 1 cm in diameter) (n = 12) MTCs were included. Both primary tumours (n = 91) and metastatic lesions (n = 31) were investigated. The specimens available were all only conventionally formalin-fixed and paraffin-embedded. The presence of neoplastic cells immunoreactive with antisera against chromogranin A (Chr A) was compared with that of the other three MTC markers. Chr A immunoreactive cells were present in practically all the cases. Similar results were obtained when the argyrophil reaction alone and CT immunoreactivity alone were used as markers. When two of the three MTC markers were combined, it was found that virtually everyone of the 122 tumours could be identified as a MTC. In contrast, the presence of amyloid deposits was found to be a less constant MTC marker; whereas 94% of the primary tumours had amyloid deposits, they were present in only approximately 70% and 60% of the metastatic and "occult" tumours respectively. No differences in the staining reaction patterns were found between familial (n = 18) and the sporadic (n = 104) types of MTC.(ABSTRACT TRUNCATED AT 250 WORDS)

Medullary (C cell) carcinoma of the thyroid with features of follicular oxyphilic cell tumours

During the last few years the spectrum of histological features seen in tumours of C cell origin has broadened and, among other variants, papillary and glandular forms have been recognized. Seven cases are now reported of medullary carcinoma with features of oxyphilic follicular cell tumours. These cases were studied with routine techniques and an immunolocalization method using antibodies to calcitonin and thyroglobulin. The tumours were mainly composed of well-demarcated eosinophilic cells of variable size arranged in trabecular, solid and follicular structures. One of the cases was negative for calcitonin but displayed strong diffuse argyrophilia and amyloid deposits; two amyloid-free tumours revealed argyrophil granules and were positive for calcitonin, the immunoreaction being inconspicuous in one however. Apart from trapped normal thyroid follicles, thyroglobulin was absent in the tumours. It is concluded that medullary carcinoma should be considered in the differential diagnosis of thyroid oxyphilic cell tumours, even when showing glandular differentiation, and that immunolocalization techniques using calcitonin and thyroglobulin in combination with methods for demonstration of argyrophil granules and amyloid are essential for accurate diagnosis of this type of medullary carcinoma of the thyroid.

Multiple endocrine neoplasia syndromes

The multiple endocrine neoplasia (MEN) syndromes are characterized by autosomal dominant inheritance with a high degree of penetrance but varying expression. This review gives a classification of these syndromes and a short summary of the historical background. The pathogenesis of the disease and its possible origin in the APUD cell system are discussed together with the mechanisms underlying normal and ectopic hormone production by MEN tumors on the basis of recent findings in molecular endocrinology. The natural history and the clinical manifestations of the different syndromes are described. The sensitivity and discriminative capacity of the tests used to detect the syndromes in an early stage are compared. The choice of therapy and criteria for the timing and extensiveness of treatment are also considered. Lastly, problems associated with the ethical and legal aspects of screening, central registration, and monitoring of relatives at risk are described.

Medullary thyroid carcinoma: prognostic factors and treatment

Seventy-five patients with medullary thyroid carcinoma (MTC) have been treated at Institut Gustave-Roussy from 1932 to 1979. Of these, 13 patients had distant metastases and received palliative treatment, their median survival was 3 years. Sixty-two patients with MTC limited to the neck received curative treatment; 6 had exclusive external radiotherapy for inoperable disease and 56 were surgically treated: 23 by total thyroidectomy and 33 by partial thyroidectomy. After surgery 29 patients received external radiotherapy for cervical lymph node involvement (25/29) and/or incomplete surgical resection (12/27). The survival rate was 69% at 5 years and 48% at 10 years. It was lower in patients with distant metastases at presentation (p less than 10(-5)), with tumoral infiltration of the posterior tissue planes (p less than 0.025) and in patients in whom surgical excision had not been satisfactory (p less than 0.01). It was not correlated with cervical lymph node involvement probably because those patients with lymph node involvement had been irradiated. The 29 patients who received post-operative cervical radiotherapy had initially more extensive local disease (p less than 0.05) than the 27 patients treated by surgery alone, nevertheless their survival was slightly higher. No difference in survival rate was observed between patients treated by total thyroidectomy or partial thyroidectomy, among whom only 4 local recurrences occurred. Three of the 6 patients treated with external radiotherapy alone experienced long survival (4, 7 and 10 years) and a fourth is still in clinical remission 4 years after treatment. The effectiveness of chemotherapy in patients with metastases was poor, only one patient out of 6 had a partial remission following a treatment by adriamycin. In the familial form and multiple endocrine neoplasia type II, total thyroidectomy appears to be indicated. In the sporadic cases, partial thyroidectomy is usually sufficient. External radiotherapy is effective in MTC and seems to be able to eradicate small foci of residual tumor; it is indicated when surgical excision is impossible or incomplete.

Medullary carcinoma of the thyroid with atypical patterns

A case of a highly invasive thyroid carcinoma, which occurred in a 68-year-old woman, was studied by light and electron microscopy, and histochemical and biochemical analysis. Light microscopical, histochemical, and biochemical features were consistent with a diagnosis of a calcitonin-producing, amyloid-rich medullary carcinoma; electron microscopical patterns, mainly the presence of lumina, microvilli, and extensively dilated cytoplasmic E.R., were reminiscent of the ultrastructural features of the follicular carcinoma. Electron-dense bodies interpreted as "secretory granules" were very scarce. This case appears very similar to the case recently presented by Valenta et al. and interpreted as a microfollicular carcinoma. The atypical features of our case of MCT seem to indicate that this tumor should be included in a group of atypical MCT; these should be kept separate from the typical (differentiated) ones on morphological, functional, and prognostic grounds.

External radiotherapy and radioiodine in the treatment of 359 thyroid cancers

Between 1943 and 1965, 359 patients with carcinoma of the thyroid were treated by external radiotherapy or radioiodine out of a total number of 560 patients treated during the same period. In 65 of these patients surgery had been satisfactory from a macroscopic point of view. Prophylactic post-operative irradiation was given to 55 and the survival rate was 91 per cent at five years and 85 per cent at ten years. Ten received radioiodine, eight were alive at five years and six at ten years. In 95 patients excision of the tumour had been macroscopically incomplete. Fifty-four were treated by external radiotherapy and the survival rates were 50 per cent at five years and 48 per cent at ten years. For the differentiated carcinoma of this group 68 per cent were surviving at five years and 58 per cent at ten years. Of 41 patients treated with radioiodine, 75 per cent were surviving at five years and 31 per cent at ten years. Eighty-five patients were inoperable. Sixty were treated by external radiotherapy, the survival rates were 17 per cent at five years and 8.5 per cent at ten years. For the differentiated carcinomas of this group the survival rates were 24 per cent and 18 per cent. Twenty-five were treated with radioiodine, 26 per cent were surviving at five years and 4.5 per cent at ten years. The patients treated by external radiotherapy can be divided into two subgroups according to the technique of treatment and dose used. Between 1943 and 1955, patients were treated with conventional X rays (mean applied dose 2,800 rads), between 1956 and 1965 the patients were treated with 60Co (mean applied dose 5,000 rads). For the 45 patients of the first group, the survival rates were 35 per cent at five years and 32 per cent at ten years. For the 124 of the second group the respective survival rates were significantly higher: 60.6 per cent and 53 per cent. The results of external radiotherapy were similar to those of radioiodine at five years and better at ten years. In conclusion, a dose of 5,000 to 6,000 rads delivered by megavoltage external radiotherapy in five to six weeks, is well tolerated and effective mostly in differentiated carcinomas and medullary carcinomas. The survival rates of 64 patients whose metastases were unable to pick up iodine is practically zero at five years. For 68 patients with uptake in their metastases the survival rates were 53 per cent at five years and 23 per cent at ten years. The survival rate in patients with pulmonary metastases was higher than in patients with bony metastases (75 per cent versus 44 per cent at five years and 42 per cent versus 8 per cent at ten years.