Clinical and pathological characteristics of secondary thyroid cancer

Although up to 24% of metastatic cancers have been reported to spread to the thyroid gland, metastases to the thyroid are not detected in clinical practice in most cases. The prognosis is poor when metastatic cancer to the thyroid occurs. The aim of this study was to examine the clinical presentation, cytopathological findings, and clinical course of secondary cancers of the thyroid. The medical records of a total of 1013 histopathologically verified thyroid cancer patients treated during the period from January 1977 to December 1995 in Chang Gung Medical Center in Linkou were analyzed retrospectively. There were 14 patients (1.4% of all thyroid cancers) with secondary cancers of the thyroid with a mean age of 55.3 +/- 16.7 years. All these patients underwent thyroid ultrasonography and a fine-needle aspiration cytology of the thyroid (FNAC) before biopsy or surgical treatment. Tissue diagnosis was obtained by biopsy or necropsy in 12 or by thyroidectomy specimens in 2 patients. Most of the patients died within 9 months of diagnosis except for 2 patients who were lost to follow-up after transferring to another hospital and 1 patient with lymphoma. Before the surgical diagnosis, there were only 7 patients who metastatic neoplasms to the thyroid gland were diagnosed by FNAC. Anaplastic thyroid carcinoma was diagnosed in 5 patients. Benign nodule was diagnosed in 1 patient and lymphoma in another patient. Most of these patients had widespread metastases to many organs, as well as the thyroid gland. As a result these patients had very short survival times. Delayed diagnosis of the thyroid metastasis was the main reason for the short survival period. In conclusion, most of the metastatic lesions presented as an advanced stage of primary cancers. FNAC was a useful tool in the diagnosis. Histopathological diagnosis by surgical open biopsy is needed for the final diagnosis.

Use of radioactive iodine for thyroid remnant ablation in well-differentiated thyroid carcinoma to replace thyroid reoperation

Complete thyroidectomy was recommended for patients with well-differentiated thyroid carcinoma to remove any potential residual contralateral cancer tissue and to facilitate detection of metastatic lesions by radioactive iodide (131I). Unfortunately, 8-32% incidence of severe complications were noted after reoperation. At present, there are still not enough data about the ablative effect of 131I for such conservative surgical treatment of well-differentiated thyroid cancers. The major goal of the present study was to examine the effects of 311I for ablation of thyroid remnants in order to obviate the severe complications associated with reoperation. From January 1977 to December 1995, 210 papillary or follicular thyroid carcinoma patients received subtotal thyroidectomy or lobectomy. After the operation, 46 of the 210 patients received 131I for remnant ablation. At doses of > or = 30 mCi 131I, 38 thyroid remnants were successfully ablated; 25 of 38 (65.8%) patients successfully ablated patients received 30 mCi 131I one-four times. Five patients expired during the follow-up period, including two follicular carcinoma patients who were misinterpreted as having benign lesions in the first operation. Patients in the overall failure versus success group for thyroid remnant ablation revealed increased age, histopathology of follicular carcinoma, higher postoperative 131I uptake in the neck bed, higher postoperative thyroglobulin levels, bigger tumor size, and higher mortality. In conclusion, repeated 30 mCi 131I treatments were adequate for most thyroid remnant ablations following subtotal thyroidectomy or lobectomy in well-differentiated thyroid cancer patients. Misinterpretation of follicular cancer as benign lesions and unresectable tumor comprised the main reasons for mortality.

Thyroid follicular neoplasms diagnosed by high-resolution ultrasonography with fine needle aspiration cytology

OBJECTIVE

To investigate the final results of cases with preoperative diagnoses of thyroid follicular neoplasms by fine needle aspiration cytology (FNAC).

STUDY DESIGN

A retrospective review of 6,499 patients who received thyroid ultrasonography with FNAC at Chang Gung Memorial Hospital. Among 6,499 patients, 209 (3.2%) were diagnosed by FNAC as having follicular neoplasms, of which 84 received surgical treatment. Eighty-two of the 84 cases had a frozen section prepared during the operation.

RESULTS

Thyroid malignancy was confirmed histopathologically in 164 cases. Among 84 thyroid follicular neoplasm patients, 21 cases were diagnosed as malignant tumors, including papillary thyroid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma and Hürthle's cell carcinoma. Ultrasonography on these 21 patients revealed that 16 cases (76.2%) had low echo density in the thyroid nodule. The percentage was statistically significantly different from that in benign cases, 23.8% (P < .05). A higher incidence of malignancy was found in males, but the data did not reach statistical significance (P = .0586).

CONCLUSION

Most of the follicular neoplasms revealed by FNAC were benign lesions. Low echo density on ultrasonography and male sex carried a higher risk of malignancy.

Prognostic variables of papillary and follicular thyroid carcinoma patients with lymph node metastases and without distant metastases

From 1977 through 1995, 1,013 thyroid carcinoma patients received treatment and were followed up at Chang Gung Medical Center in Taiwan. To evaluate the prognostic variables of papillary and follicular thyroid carcinomas with limited lymph node metastases, a retrospective review of these patients was performed. Of these patients, 910 had papillary or follicular thyroid carcinoma, and 119 patients were categorized as clinical stage 2 with limited neck lymph node metastases only at the time of diagnosis. The patients were categorized into two groups as no recurrence and local recurrence or distant metastasis at the end of 1997. After the operations, radioactive iodide (131I) treatments were performed in 114 patients and external radiotherapy for neck region or distant metastases in 18 patients. The median follow-up period of these patients was 5.4 years. Clinical variables were coded in our computer for statistical analysis. After the treatments, 93 patients remained disease-free; 10 were in stage 2; 5 in stage 3; and 11 aggravated to stage 4. Of the clinical variables, age, post-operative first 1311 uptake scans, and 1-month post-operative thyroglobulin levels revealed statistically significant differences between the group which improved and the group which did not. During the follow-up period, five patients died; three patients died of thyroid cancer and two died of intercurrent diseases. Patients with papillary thyroid carcinoma revealed a higher percentage of lymph node metastases. Although limited lymph node metastases did not influence survival rate, patients with poor prognostic factors need more aggressive treatment to avoid progression of the cancer.

Thyroid ultrasonography with fine-needle aspiration cytology for the diagnosis of thyroid cancer

This series retrospectively reviewed 3657 patients who received thyroid ultrasonography with fine-needle aspiration cytological (FNAC) examinations at Chang Gung Memorial Hospital during the period from January 1, 1993 to December 31, 1993. Thyroid ultrasonography studies were performed using a real-time ultrasonographic machine with a 10 MHz transducer. The aspirates were air dried and stained by the Romanowsky-based Liu method. Three hundred seventy-eight cases (10.3%) received surgical treatment after the ultrasonographic and FNAC examinations. Benign lesions were diagnosed in 269 patients. Thyroid malignancy was confirmed histopathologically in 109 cases including 76 papillary thyroid carcinomas, 17 follicular carcinomas, 5 medullary thyroid carcinomas, 3 anaplastic carcinomas, 3 Hürthle cell carcinomas, and 3 lymphomas. Another 2 cases were metastatic cancer to thyroid. The results demonstrated that 28.8% of the surgically treated patients had histopathologically proven malignancies. The incidence of thyroid malignancy was 2.98% in this study. The sensitivity of the cytological diagnosis was 79.80% and the specificity was 98.66%. The positive predictive value was 96.34%. Negative predictive value was 91.70%. The false negative index was 20.20%. The diagnostic accuracy was 92.89%. Thyroid ultrasonography with the FNAC can provide high specificity and sensitivity in differentiating malignant lesions from benign.

Application of three-dimensional body scanner: observation of prevalence of metabolic syndrome

BACKGROUND AND AIMS

This retrospective cross-sectional study correlates blood pressure, blood glucose, lipid and uric acid levels with anthropometric measurements.

METHODS

A total of 3975 visitors to the Department of Health Management were randomly selected to participate in this cross-sectional study. Whole body three-dimensional (3-D) laser scans were used to obtain anthropometric measurements. A health index (HI) was also designed based on anthropometric parameters. Subjects were defined as having metabolic syndrome when three of the following criteria were met: obesity (BMI of at least 30 kg/m(2); or a WHR of over 0.9 for males and 0.85 for females); triglyceride of at least 150 mg/dl; high-density lipoprotein (HDL)-cholesterol below 35 mg/dl for males and 39 mg/dl for females; fasting sugar levels of at least 110 mg/dl and hypertension.

RESULTS

Of 3975 subjects, 341 (8.6%) met the criteria for diabetes mellitus (DM); of these, 32.8% were diagnosed with hypertension. This proportion exceeded 18% of the subjects had normal glucose levels. Of the 3975 subjects, 658 (16.6%) met the criteria for metabolic syndrome. Proportionally, more male subjects than female subjects were diagnosed with metabolic syndrome (18.5% vs 14.7%). Of these, central obesity, elevated triglyceride and low HDL-cholesterol were the main factors in men, while fasting glucose, hypertension and central obesity were the main factors in women. This investigation found that larger proportions of subjects with impaired glucose tolerance (41.1%) and DM (64.2%) than of subjects with normal glucose subjects, suffered from metabolic syndrome (9.5%).

CONCLUSIONS

3-D body scanning is useful in correlating pertinent factors with metabolic syndrome, these factors include central obesity, hyperglycemia, dyslipidemia, hyperuricemia and hypertension.

Characteristics of thyroid carcinomas in aging patients

BACKGROUND

To investigate the clinical features of thyroid cancer in aging patients and to present the results of treatment. From this we can provide bases for earlier diagnoses and better treatment of thyroid malignancies in older patients.

MATERIALS AND METHODS

In this study a retrospective analysis was performed with 204 thyroid cancer patients aged 60 years or older (132 women, with a mean age of 68.3 +/- 6.6 years; 72 men, with a mean age of 67.0 +/- 5.3 years).

RESULTS

Of the 204 patients, 142 had well-differentiated thyroid carcinomas (96 papillary thyroid carcinomas, 43 follicular carcinomas, three Hürthle cell carcinomas) and three medullary carcinomas. Sixty-nine (33.8%) of the 204 patients died after treatment. Of these, three patients died of causes not related to thyroid cancer. For well-differentiated thyroid carcinomas, male gender, follicular carcinoma, and a larger tumour size indicated a poor prognosis. Of the 59 non-well-differentiated thyroid carcinomas, 39 were anaplastic thyroid carcinomas, nine metastatic cancers of the thyroid, seven lymphomas, and four squamous cell carcinomas. After treatment, 40 (67.8%) of the 59 patients died. In multivariant analysis of the differences in clinical parameters between aging and younger thyroid cancer patients, the current status, tumour size, follow-up period, sex, and stage at diagnosis were independent factors. From this data the delayed diagnosis of aging patients with thyroid cancer was of note when compared with younger patients.

CONCLUSION

Thyroid cancer in older patients is not a benign clinical disorder. Early diagnosis and urgent aggressive treatment are recommended courses of action for this type of cancer, especially for non-well-differentiated thyroid cancers.

Characterization and Application of an Alginate Lyase, Aly1281 from Marine Bacterium Pseudoalteromonas carrageenovora ASY5

Alginate extracted from widely cultured brown seaweed can be hydrolyzed by alginate lyase to produce alginate oligosaccharides (AOS) with intriguing biological activities. Herein, a novel alginate lyase Aly1281 was cloned from marine bacterium Pseudoalteromonas carrageenovora ASY5 isolated from mangrove soil and found to belong to polysaccharide lyase family 7. Aly1281 exhibited maximum activity at pH 8.0 and 50 °C and have broad substrate specificity for polyguluronate and polymannuronate. Compared with other alginate lyases, Aly1281 exhibited high degradation specificity and mainly produced di-alginate oligosaccharides which displayed good antioxidant function to reduce ferric and scavenge radicals such as hydroxyl, ABTS+ and DPPH. Moreover, the catalytic activity and kinetic performance of Aly1281 were highly improved with the addition of salt, demonstrating a salt-activation property. A putative conformational structural feature of Aly1281 was found by MD simulation analysis for understanding the salt-activation effect.

Chiral terahertz wave emission from the Weyl semimetal TaAs

Weyl semimetals host chiral fermions with distinct chiralities and spin textures. Optical excitations involving those chiral fermions can induce exotic carrier responses, and in turn lead to novel optical phenomena. Here, we discover strong coherent terahertz emission from Weyl semimetal TaAs, which is demonstrated as a unique broadband source of the chiral terahertz wave. The polarization control of the THz emission is achieved by tuning photoexcitation of ultrafast photocurrents via the photogalvanic effect. In the near-infrared regime, the photon-energy dependent nonthermal current due to the predominant circular photogalvanic effect can be attributed to the radical change of the band velocities when the chiral Weyl fermions are excited during selective optical transitions between the tilted anisotropic Weyl cones and the massive bulk bands. Our findings provide a design concept for creating chiral photon sources using quantum materials and open up new opportunities for developing ultrafast opto-electronics using Weyl physics.

Outcome of pregnancy after radioactive iodine treatment for well differentiated thyroid carcinomas

This study sought to determine the outcome of pregnancy in female patients with differentiated thyroid carcinoma who became pregnant after radioactive iodide treatment. A total of 779 female thyroid cancer patients were treated at Chang Gung Medical Center in Linkou between January 1977 and December 1995. The medical records of these patients were reviewed retrospectively. Thirty-seven of these patients had well differentiated thyroid carcinoma receiving 131I treatment and conceived at a mean age of 27.97 +/- 3.49 year-old. A total of 58 pregnancy episodes were recorded during this study period. Among these 37 patients, 3 episodes of artificial abortion, 8 episodes of spontaneous abortion and 2 threatened abortions were observed. These patients delivered a total of 47 babies including 3 premature babies. Seven of these patients conceived within 6 months after the last administration of 131I, including 2 cases within 1 month, 4 cases within 4 months, and 1 patient within 5 months. Of these 7 patients, only one patient who conceived within 6 months after the last administration of 131I (14.3%) had a spontaneous abortion. The present results suggest that previous administration of 131I in female patients with well differentiated thyroid cancer does not result in demonstrable adverse effects in subsequent pregnancies. However, further studies involving long-term follow-up of children delivered by mothers who became pregnant within 6 months after the last administration of 131I is needed to further elucidate the possible chronic effects and sequelae of 131I therapy on subsequent pregnancies.

Extraction, Modification and Biomedical Application of Agarose Hydrogels: A Review

Numerous compounds present in the ocean are contributing to the development of the biomedical field. Agarose, a polysaccharide derived from marine red algae, plays a vital role in biomedical applications because of its reversible temperature-sensitive gelling behavior, excellent mechanical properties, and high biological activity. Natural agarose hydrogel has a single structural composition that prevents it from adapting to complex biological environments. Therefore, agarose can be developed into different forms through physical, biological, and chemical modifications, enabling it to perform optimally in different environments. Agarose biomaterials are being increasingly used for isolation, purification, drug delivery, and tissue engineering, but most are still far from clinical approval. This review classifies and discusses the preparation, modification, and biomedical applications of agarose, focusing on its applications in isolation and purification, wound dressings, drug delivery, tissue engineering, and 3D printing. In addition, it attempts to address the opportunities and challenges associated with the future development of agarose-based biomaterials in the biomedical field. It should help to rationalize the selection of the most suitable functionalized agarose hydrogels for specific applications in the biomedical industry.

Identifying differentially expressed genes associated with metastasis of follicular thyroid cancer by cDNA expression array

Patients with follicular thyroid carcinoma have a higher incidence of metastasis than papillary thyroid carcinoma when thyroid cancer is diagnosed. The cDNA expression array technology is utilized herein to profile differentially expressed genes from metastatic human follicular thyroid carcinoma and reveal new tumor markers as well as target genes for therapeutic intervention. Tissue samples were obtained during surgical resection of the thyroid follicular carcinoma and metastatic tissue in the brain of the same patient. Two identical Atlas human cDNA expression arrays were hybridized with 32P-labeled cDNA probes derived from RNA of either primary thyroid cancer or metastatic tissue. Parallel analysis of the hybridized signals allowed us to identify the alteration of gene expression in the metastasis process. Eighteen genes significantly overexpressed and 40 genes significantly underexpressed were identified in the metastatic thyroid cancer. Genes that displayed an altered expression were associated with the processes of cell cycle regulation, apoptosis, DNA damage response, angiogenesis, cell adhesion and mobility, invasion, and immune response. An expression profile of genes that are associated with metastasis process of follicular thyroid cancer was also discussed. Further investigation is required to understand the precise relationship between the altered expression of these genes and the metastasis process of follicular thyroid cancer.

Results of external beam radiotherapy in patients with well differentiated thyroid carcinoma

Surgical, thyroid hormone and radioactive 131I therapy are the standard curative treatments for well differentiated thyroid cancer. However, for residual, recurrent and nodal involvement of well differentiated thyroid cancer, external radiotherapy may be important in preventing distant metastases. The postoperative treatment of well differentiated human thyroid cancer with external radiotherapy is controversial. We retrospectively reviewed the records of 699 patients with papillary or follicular thyroid cancer, of whom 72 received external radiotherapy treatment after surgery. Thirty-two of these patients were at clinical stage 2 or 3 at the time of diagnosis while 172 patients at clinical stages 2 or 3 did not receive external radiotherapy after surgery. The patients who received external radiotherapy were older than those who did not (42.9 +/- 14.5 vs. 38.6 +/- 15.3), although this was not statistically significant. There were no significant differences in clinical parameters including surgical methods employed, histopathological types of cancer, follow-up stages, postoperative thyroglobulin levels, tumor size, accumulated 131I doses and survival rates between the two groups. To clarify the effect of external radiotherapy in patients with local invasion, we compared the survival rates of the patients with clinical stage 3 in the two groups and again no significant difference was found. During the follow-up period, 21 (28.4%) of the 72 patients who received external radiotherapy died of thyroid carcinoma. In our limited period of study, external radiotherapy did not improve the survival rate of patients with well differentiated thyroid cancer, though it appeared to cause temporary tumor regression.

Ethyl pyruvate administration suppresses growth and invasion of gallbladder cancer cells via downregulation of HMGB1-RAGE axis

High mobility group box B1 (HMGB1)-receptor for advanced glycation end products (RAGE) axis has been previously known to be involved in carcinogenesis and development of multiple malignancies. Some studies have confirmed that Ethyl pyruvate (EP), a potent inhibitor of HMGB1, exerts the therapeutic effects on metastatic live tumor from gastric cancer. However, the effects and possible molecular mechanisms of EP on gallbladder cancer (GBC) need to be further explored. In the present study, human GBC cell lines (GBC-SD and SGC-996) were treated with different concentrations of EP. Then, the expression levels of HMGB1, RAGE and some transcription factors were identified by Real-time PCR and Western blot assays. Cell proliferative activities indicated by MTT assay, invasive potential by Transwell assay and cell apoptosis and cycle distribution were performed for functional analysis of GBC cell lines in vitro. As a result, EP decreased the expression of HMGB11, RAGE, PCNA and matrix metallopeptidase-9 (MMP-9), while it increased the expression of p53. Moreover, EP administration decreased GBC cell proliferation, inhibited the invasive potential, and induced apoptosis and cycle arrest in S phase in GBC cells. In conclusion, EP administration inhibits growth and invasion of gallbladder cancer cells possibly via down-regulation of the HMGB1-RAGE axis, suggesting that EP may play a critical role in the treatment of cancer in conjunction with other therapeutic agents.

Establishment of xenografts and cell lines from well-differentiated human thyroid carcinoma

BACKGROUND

Our aim was to establish Chinese human thyroid cancer cell lines and to provide the material for thyroid cancer research.

METHODS

We collected thyroid cancer tissues from 93 patients with thyroid cancer for developing the primary culture. Thyroid cancer tissues were verified by frozen sections during the operations, then subjected to primary cell culture. During the first several passages, fibroblasts were removed by selective attachment.

RESULTS

From the 93 cancer tissues used, two follicular cancer tissues from the metastatic area (CGTH W-1, CGTH W-2) and one papillary thyroid cancer tissue (CGTH W-3) could be passed over 50 times. Cellular transformation with loss of contact inhibition occurred during passages 5-8. Electron microscopic studies of the CGTH W-1 cell line showed the presence of an abundance of mitochondria and Golgi complex. Presence of microvilli with interdigitations between neighboring cells were found in CGTH W-2 and CGTH W-3 cell lines. Severe combined immunodeficient (SCID) mice were used to determine whether these cells were tumorigenic. Two months after transplantation of 1 x 10(7) CGTH W-1, 2, and 3 cells into SCID mice, subcutaneous tumors approximately 2-2.5 cm in size were clearly visible. After affinity cross-linking an IGF-I with insulin-like growth factor binding proteins complex corresponding to a molecular size of 41 kDa was observed in culture media collected from CGTH W-1, SW 579, and RO82 W-1 cells.

CONCLUSIONS

Three thyroid cancer cell lines were established, which may provide material for future thyroid cancer research.

Cloning, expression, and characterization of a new pH- and heat-stable alginate lyase from Pseudoalteromonas carrageenovora ASY5

Alginate lyase is important in marine alginate degradation, and its enzymatic hydrolysates are excellent antioxidants. Here, we cloned a new alginate lyase, that is, Alg823, from the Gram-negative marine bacterium Pseudoalteromonas carrageenovora ASY5. The optimal temperature and pH of Alg823 were 55°C and pH 8.0, respectively. After 30 min of incubation at 50°C, Alg823 could maintain over 75.0% of the maximum enzyme activity, suggesting its thermostability. The recombinant alginate lyase retained more than 80.0% of the maximum enzyme activity after it was treated at pH 6.0-10.0 and 4°C for 24 hr, indicating its excellent pH stability. Mg²⁺ , Ca²⁺ , Na⁺ , and K⁺ could promote enzyme activity. Alginate oligosaccharides obtained by degradation with Alg823 displayed an excellent ability to scavenge ABTS, hydroxyl, and DPPH radicals. Alg823 showed potential for novel applications in alginate oligosaccharide production because of its pH tolerance and heat adaptation. PRACTICAL APPLICATIONS: Alginate oligosaccharides produced by alginate degradation possess favorable properties, such as low molecular weight, high stability, and co-dissolution with water. These oligosaccharides also have many biological activities. As such, they have been widely explored. Alginate oligosaccharides are prepared via three methods, namely, physical, chemical, and enzymatic methods. In chemical method, operational processes are difficult to thereby possibly damaging the unique structure of polysaccharides and causing environmental pollution. Although physical methods can overcome some of the shortcomings of chemical methods, their reaction is still difficult to control, and products are complicated. Conversely, enzymatic methods can has advantages of mild conditions, single product, and less pollution. Furthermore, oligosaccharides prepared by enzymatic methods are more biologically active than those prepared by other methods. Thus, finding novel alginate lyase with high activity and stability is important for research and commercial purposes.

Extraction of sulfated agar from Gracilaria lemaneiformis using hydrogen peroxide-assisted enzymatic method

In this study, an eco-friendly extraction method was explored to obtain high sulfate content agar and repair the deficiency of enzymatic extraction by taking full advantage of H₂O₂. The sulfate content of EHA (H₂O₂-assisted enzymatic extracted agar) reached 3.56 %, which is significantly higher than that of traditional alkali-extracted agar (AA, 1.8 %). Moreover, EHA exhibited lower viscosity (9.4 cP), which improved 26.6 % and 14 % of filtration and gel dehydration rates than EA (enzymatic extracted agar), respectively. Additionally, the physicochemical properties of the agars were evaluated and compared. Among these agars, EHA showed some favorable properties, such as high yield (16.08 %) and low dissolution temperature (88.9 °C). The surface of algae became smoother after treatment with H₂O₂ due to effective degradation of cellulose. Besides, mass spectrometry analysis revealed that EHA preserved a great amount of sulfate, while thermogravimetric analysis suggested that the thermal stability of EA and EHA both decreased.

The Moloney leukemia retroviral long terminal repeat trans-activates AP-1-inducible genes and AP-1 transcription factor binding

Moloney murine leukemia virus (Mo-MuLV) is a thymotropic and leukemogenic retrovirus which causes T lymphomas. The long terminal repeat (LTR) of Mo-MuLV affects the regulation of a number of cellular genes, including collagenase IV, monocyte chemoattractant protein-1, and c-jun genes, all of which contain 12-O-tetradecanoylphorbol-13-acetate-responsive element consensus sites within their promoters. We report here that Mo-MuLV stimulates the collagenase IV gene through transcription factor AP-1, and that the expression of a subgenomic portion of Mo-MuLV LTR alone is sufficient for this effect. Transient or stable expression of the viral LTR increases cellular AP-1 DNA binding activity. The collagenase IV 12-O-tetradecanoylphorbol-13-acetate-responsive element consensus sequence was shown to be required for this trans-activation. Deletions or mutations of this consensus site which abolished AP-1 binding also abolished trans-activation by the LTR. Transient or stable transfection of the viral LTR into cells stimulated c-jun gene expression, suggesting one mechanism whereby the viral LTR may induce cellular AP-1 activity. Thus, the Mo-MuLV LTR, through activation of the transcription factor AP-1, is capable of regulating cellular gene expression, including the induction of proto-oncogenes. This activity may be relevant to the mechanisms whereby retroviruses which do not contain oncogenes induce neoplasia.

Thyroid cancer treated in Chang Gung Memorial Hospital (northern Taiwan) during the period 1979-1992: clinical presentation, pathological finding, analysis of prognostic variables, and results of treatment

This study is a retrospective analysis of 248 thyroid cancer patients who received their primary treatment in the Chang Gung Memorial Hospital during the period January 1979 to December 1992. Among these cases, there were 173 papillary thyroid cancers (69.8%), 52 cases of follicular thyroid cancer (21%), 7 cases of medullary thyroid cancer (2.8%), and 16 cases of anaplastic thyroid cancer (6.5%). The subjects included 184 female patients with a mean age of 40.7 +/- 14.3 years and 64 males patients with a mean age of 49.2 +/- 14.3 years. Most of the cases had a nearly total thyroidectomy after the diagnosis was confirmed by frozen section during the operation. During the follow-up period, 19 (8.2%) patients diagnosed with well-differentiated thyroid cancer died of thyroid cancer in contrast to 12 patients (75%) with anaplastic thyroid cancer. The 1-year Greenwood survival probabilities after the disease is diagnosed in papillary, follicular, and anaplastic thyroid cancer are 0.98, 0.86, and 0.25, respectively. For the analysis of prognostic variables in well-differentiated thyroid cancer patients, 16 factors were entered for univariate and multivariate analysis. Using a log-rank univariate analysis, survival was significantly associated with the cell type of the primary tumor, age, clinical staging, postoperative 131I pattern, tumor size, postoperative thyroglobulin (Tg) level and postoperative x-ray results. In the Cox multivariate regression analysis the combination factors that gave the best prognostic value were the association of x-ray finding (P = .004), age (P = .017), and Tg level (P = 0.19). In conclusion, thyroid cancer is not an unusual disease in Taiwan. As previously reported anaplastic thyroid cancer has a poor prognosis. In this limited period of follow-up study, the patients' age with postoperative first positive x-ray finding and Tg level may provide the prognostic factors for patients with well-differentiated thyroid cancer.

Relative value of thallium-201 and iodine-131 scans in the detection of recurrence or distant metastasis of well differentiated thyroid carcinoma

Radioactive iodine (131I) has been found to be more sensitive and more specific than thallium-201 for the detection of distant metastases and thyroid remnants in the neck in cases of well-differentiated thyroid carcinoma. 201Tl has been deemed particularly useful in localizing metastases or recurrence in patients with a negative 131I scan and abnormal levels of serum thyroglobulin (Tg). This study aimed to: (1) determine the value of 201Tl imaging in localizing metastases or recurrence in patients with well-differentiated thyroid carcinoma, and (2) evaluate the false-positive and false-negative results of 131I and 201Tl scintigraphy. Sixty-two thyroid remnant ablated patients who underwent simultaneous postoperative 201Tl and 131I scans and and serum Tg determinations were evaluated. Fifty patients had papillary thyroid carcinomas and 12 had follicular thyroid carcinomas. 201Tl imaging was performed before the 131I studies. Of the 62 patients who underwent 201Tl imaging studies, 24 were found to have positive results, with local recurrence or distant metastases. Patients with positive results in the 201Tl imaging studies tended to be older, were mor often male, had higher Tg levels and had a higher recurrence rate. Of these 24 patients, ten had negative diagnostic or therapeutic 131I scans. Concurrently, serum Tg levels were less than 5 ng/ml in five of these ten patients. Three patients were deemed false positive by 201Tl scans; one had a parotid tumour, one a periodontal abscess and one lung metastasis. Among the 38 patients with negative 201Tl scans, 11 had positive findings on 131I scans. Three had distant metastases: two with lung metastases and one with bone metastases. Patients with false-positive results on 131I scans included those with biliary tract stones, ovarian cysts, and breast secretion. Of the 27 patients with negative 201Tl and 131I scans, 15 had elevated serum Tg levels. Among these, local recurrence followed by lung metastases was manifested in a 49-year-old male with papillary thyroid carcinoma. In conclusion, both 131I and 201Tl scans are useful in the detection of recurrence or distant metastasis of well differentiated thyroid cancers. 201Tl scan could in particular be used in patients with a negative 131I scan in conjunction with an elevated Tg level.

Prognostic variables of papillary thyroid carcinomas with local invasion

To evaluate the significance of the extrathyroid extension (ETE) of papillary thyroid carcinoma at the time of diagnosis and the prognostic variables of patients, we retrospectively reviewed 1,013 thyroid cancer patients. Of the 741 papillary thyroid cancer patients, 466 (62.9%) were categorized in clinical stage I and 114 (15.4%) were categorized in clinical stage III. Of the 114 patients in clinical stage III, 81 were female (mean age 44.4 +/- 15.7 years) and 33 were male (mean age 46.9 +/- 18.1 years). Of the clinical stage III patients, 104 patients received post-operative radioactive iodide (131I) therapy while 22 patients received external radiotherapy in the neck and upper mediastinum area post-operatively. In the study, age, gender, 131I accumulated dose, post-operative serum thyroglobulin (Tg) levels, and survival rate were demonstrated to be statistically significant in the groups with no recurrence and recurrence after treatment. The average follow-up period of these patients was 6.0 years. During this follow-up period, 11 patients expired. Eight died of thyroid cancer (7.0%) and 3 died of intercurrent diseases including asthma, renal cell carcinoma and propranolol overdose. Four of the 8 patients (50%) died of airway obstruction due to cancer cell invasion. Another 4 died of distant metastases, including 2 patients with skull metastases and brain invasion. The 5- and 10-year survival rates were 0.981 and 0.956 in clinical stage I and 0.923 and 0.843 in clinical stage III, respectively. In conclusion, the survival rate of the ETE of papillary thyroid cancer was lower when compared with stage I, especially in older male patients with higher post-operative serum Tg levels.

Clinical presentations and treatment for 74 occult thyroid carcinoma. Comparison with nonoccult thyroid carcinoma in Taiwan

There is limited clinical information of Chinese patients with occult well-differentiated thyroid cancer (OTC). The purposes of this study were to elucidate the clinical presentations and results of treatment in the patients with OTC in Taiwan. The data of 568 patients with pathologically verified papillary and follicular thyroid carcinomas who received primary treatment in Chang Gung Memorial Hospital were retrospectively reviewed. Seventy-four of 568 patients with well-differentiated thyroid carcinoma were OTC; those included 71 papillary thyroid carcinomas and three follicular carcinomas. Among the 74 OTC patients, five cases (6.8%) presented with distant metastases, but 41 cases (10.1%) were found with distant metastases in 416 nonoccult thyroid cancer (NOTC) (p = 0.509). In the five OTC with distant metastases, there were three papillary carcinomas and two follicular carcinomas. Only one case (1.4%) died of distant metastasis of the occult papillary thyroid carcinoma versus 20 cases out of the total 568 (4.1%) well-differentiated thyroid carcinomas. After statistical analysis, there were no differences between the survival rates of OTC and NOTC patients. In the present study, 1 month postoperative serum thyroglobulin level could be used as prognostic factor in both OTC and NOTC patients. Only 54.17% of OTC patients were diagnosed as thyroid cancer by thyroid ultrasonography with the fine needle aspiration cytology. In conclusion, most OTC had relatively benign clinical courses, but distant metastases may result in mortality still observed. Therefore, OTC should be treated as NOTC, since relatively high rate of distant metastases were found in the patients with OTC.

Moloney murine leukemia virus long terminal repeat activates monocyte chemotactic protein-1 protein expression and chemotactic activity

Moloney murine leukemia virus (Mo-MuLV) is a thymotropic and leukemogenic retrovirus which causes T lymphomas. Recently, Mo-MuLV has been shown to trans-activate cellular genes. Monocyte chemoattractant protein-1 (MCP-1) is a chemokine which can promote the migration and diapedesis of monocytes and lymphocytes, as well as inducing metastasis of lymphomas. Here we demonstrate that introduction of Mo-MuLV or the MuLV LTR alone, transiently or stably, into Balb/c-3T3 cells or HeLa cells resulted in 9-11 fold increases in MCP-1 transcripts. This trans-activation of the MCP-1 gene by the Mo-MuLV LTR is independent of the physical location of the MCP-1 gene or of the LTR, occurring whether the LTR or the MCP-1 gene is integrated in the genome or transiently expressed. Immunoblot analysis using an anti-MCP-1 polyclonal antibody showed that the expression of the MuLV LTR in HeLa cells also induced the appearance of the MCP-1 protein. Boyden Chamber analysis demonstrated that the MCP-1 chemotactic activity produced by HeLa cells with an integrated MuLV LTR was elevated by 11 fold and that neutralizing antibody to human MCP-1 abrogated monocyte migration in response to MuLV LTR expression. Promoter deletional analysis showed the LTR responsive cis-acting element in the MCP-1 promoter is located between -141 and -88. Deletion of this region abolished the trans-activation of MCP-1 by the LTR. These LTR-mediated activations of a chemotactic and inflammatory cytokine may be relevant as mechanisms whereby retroviruses which do not contain oncogenes can induce neoplasia.

Activation of collagenase IV gene expression and enzymatic activity by the Moloney murine leukemia virus long terminal repeat

Moloney murine leukemia virus (Mo-MuLV) is a thymotropic and leukemogenic retrovirus which causes T lymphomas and leukemias, yet does not contain a transforming gene product. Mo-MuLV has been shown to trans-activate cellular genes via a polymerase III-generated transcript, designated let, from the long terminal repeat (LTR). Here we demonstrate that introduction of the Mo-MuLV LTR stably, or transiently, into murine or human cultured cells resulted in an 8- to 15-fold increase in collagenase IV (92-kDa gelatinase, gelatinase B, matrix metalloproteinase-9) gene expression. Collagenase IV protein expression was induced 9-fold by stable integration of MuLV LTR, as measured by immunoblot analysis using an anti-collagenase IV polyclonal antibody. The MuLV LTR coordinately stimulated the proteolytic activity of collagenase IV by 14-fold. The AP-1-binding site in the collagenase IV promoter was required for transactivation by the LTR. Collagenase type IV degrades type IV collagen, a major component of basement membrane, which constitutes the first step of the metastatic cascade. The activation of proteolytic enzymes by the MuLV LTR may thus play a contributory role in the development or spread of virus-induced lymphomas or leukemias.