Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy

BACKGROUND

TIR3B thyroid nodules are considered to be at risk of malignancy (15-30%) but guidelines recommend conservative surgery with lobectomy with primary diagnostic porpoise. Risk stratification mainly based on ultrasound, elastography and genetic mutations usually may influences the surgical approach.

METHODS

We retrospectively analyzed 52 cases of TIR3B underwent between 2015 and 2017 total thyroidectomy (TT) and lobectomy (L), focusing mainly on the observed rate of malignancy. Chi-squared test and Fisher's exact probability test were used for analysis, considering a P values less than 0.05 as significant.

RESULTS

Out of 52 patients 49 underwent TT and 3 L. In TT group a multinodular goiter was associated in 67.3% of patients. Malignancy rate was 81.6 and 33.3% respectively after TT and L (P 0.003). Multicentric and contralateral tumors were detected respectively in 36.7% and in 32.6% of patients underwent TT. No main post-operative complications were registered.

CONCLUSIONS

Ultrasound and elastography are useful to define within the TIR3B group those lesions at higher risk and therefore requiring a more radical approach. TT seems an appropriate approach to TIR3B lesions, especially in multinodular goiter, considering the incidence of malignancy with probably higher rate than previously reported.

Metaplastic carcinoma of the breast: Treatment, results and prognostic factors based on international literature

Metaplastic carcinoma of the breast (MCB) is a rare form of cancer containing mixture of epithelial and mesenchymal elements in variable combinations. Few and conflicting clinical data are available in the literature addressing optimal treatment modalities, prognosis and outcome. A retrospective study was conducted to review all patients with MCB diagnosed and treated at Breast Unit of Azienda Ospedaliera "Santa Maria" Terni - Italy between 2001/2010. The aim is to describe patient's clinic pathologic features and to analyze treatment results. Six female patients were studied. The median age was 48 years (range 14/58). The median tumor size was 9 cm. (range 3/18 cm.). Two cases (33%) were identified as purely epithelial and 4 (67%) as mixed epithelial and mesenchymal metaplasia. Hormone receptors were positive in only 2 patients. Modified radical mastectomy performed in 3 patients and 5 underwent axillary node dissection. Adjuvant chemotherapy was given to all patients and postoperative radiotherapy to 4. Four patients relapsed with median time of relapse of 12 months. MCB is an aggressive form of breast cancer associated with poor outcome, high incidence of local recurrence and pulmonary metastases. The disease tends to be estrogen/progesterone receptor negative. Tumor size has an important impact on outcome. The best treatment approach is yet to be defined.

Juvenile papillomatosis of the breast in young male: a case report

Juvenile papillomatosis of the breast ("Swiss cheese disease'') is a benign localized proliferative condition of the breast which occurs almost exclusively in young adult women. Patients with this lesion often have a family history of breast carcinoma, but rarely carcinoma may coexist with the lesion at the time of diagnosis. We present a case of a young male with juvenile papillomatosis of the breast. The pathology and clinical management of this rare lesion is discussed.

BRCA1: a novel prognostic factor in resected non-small-cell lung cancer

BACKGROUND

Although early-stage non-small-cell lung cancer (NSCLC) is considered a potentially curable disease following complete resection, patients have a wide spectrum of survival according to stage (IB, II, IIIA). Within each stage, gene expression profiles can identify patients with a higher risk of recurrence. We hypothesized that altered mRNA expression in nine genes could help to predict disease outcome: excision repair cross-complementing 1 (ERCC1), myeloid zinc finger 1 (MZF1) and Twist1 (which regulate N-cadherin expression), ribonucleotide reductase subunit M1 (RRM1), thioredoxin-1 (TRX1), tyrosyl-DNA phosphodiesterase (Tdp1), nuclear factor of activated T cells (NFAT), BRCA1, and the human homolog of yeast budding uninhibited by benzimidazole (BubR1).

METHODOLOGY AND PRINCIPAL FINDINGS

We performed real-time quantitative polymerase chain reaction (RT-QPCR) in frozen lung cancer tissue specimens from 126 chemonaive NSCLC patients who had undergone surgical resection and evaluated the association between gene expression levels and survival. For validation, we used paraffin-embedded specimens from 58 other NSCLC patients. A strong inter-gene correlation was observed between expression levels of all genes except NFAT. A Cox proportional hazards model indicated that along with disease stage, BRCA1 mRNA expression significantly correlated with overall survival (hazard ratio [HR], 1.98 [95% confidence interval (CI), 1.11-6]; P = 0.02). In the independent cohort of 58 patients, BRCA1 mRNA expression also significantly correlated with survival (HR, 2.4 [95%CI, 1.01-5.92]; P = 0.04).

CONCLUSIONS

Overexpression of BRCA1 mRNA was strongly associated with poor survival in NSCLC patients, and the validation of this finding in an independent data set further strengthened this association. Since BRCA1 mRNA expression has previously been linked to differential sensitivity to cisplatin and antimicrotubule drugs, BRCA1 mRNA expression may provide additional information for customizing adjuvant antimicrotubule-based chemotherapy, especially in stage IB, where the role of adjuvant chemotherapy has not been clearly demonstrated.

Ret/PTC activation does not influence clinical and pathological features of adult papillary thyroid carcinomas

OBJECTIVE

RET proto-oncogene rearrangements (ret/PTCs) represent the most common genetic alterations found in papillary thyroid carcinomas (PTCs). Correlation of ret/PTC expression with clinical outcome is controversial. The aim of the present study was to analyze the frequency of RET rearrangements in adult PTCs, and to investigate if ret/PTCs influence biological behavior and clinical features of the cancers.

DESIGN

Ret/PTC rearrangements were looked for in tIssue samples of 48 PTCs collected at our institution. Data about clinical and pathological features of the tumors were also reviewed. Three separate association analyses were carried out on the cohort evaluating the effects of, respectively, ret/PTC positivity, preferential RET tyrosine kinase domain (RET-TK) expression, and ret/PTC plus RET-TK positivity, on age, sex, tumor size, staging, number of neoplastic foci, and histological subtype.

METHODS

The genetic study was conducted with the RT-PCR-Southern blot technique. Standard Student's t-test and Fisher exact test were applied for the association analyses.

RESULTS

The molecular genetic study demonstrated the positivity of ret/PTC1 and ret/PTC3 in 13 of 48 tumors (27.1%), and an exclusive or preferential RET-TK expression in 17 cases (35.4%). None of the three genetico-clinical analyses showed any significant association between ret/PTC expression and the clinical and pathological features of the cancers.

CONCLUSIONS

These data indicate that RET rearrangements may not play any distinctive role in driving histotype development and cancer progression in these neoplasms. Moreover, they weaken the possibility of using ret/PTC as a prognostic marker for papillary thyroid carcinomas.

Long-term safety and tolerance of silicone and self-expandable airway stents: an experimental study

BACKGROUND

A variety of respiratory stents are currently available, but the ideal airway prosthesis seems far from being recognized. The objective of this study was to verify safety and long-term effect on the bronchial wall of three different types of airway stents.

METHODS

Twelve healthy adult sheep were divided in three groups, scheduled to receive: (1) bare self-expandable metallic stents (Gianturco); (2) silicone stents (Dumon); and (3) covered self-expandable synthetic stents (Polyflex). Insertions were performed through a rigid bronchoscope under general anesthesia. Chest roentgenogram was performed 1 and 6 months after surgery, and flexible bronchoscopy after 6 months. Twelve months postoperatively, the animals were killed and a postmortem examination was carried out.

RESULTS

All Polyflex stents migrated during the observation period; one late migration was observed in the Dumon group. Microscopic study showed: (1) Gianturco stents: full-thickness perforation of the bronchial wall covered by a thick layer of a chronic inflammatory infiltrate. Infection by Candida at the bottom of some ulcerations; (2) Dumon stents: mild bronchial inflammation (squamous metaplasia, submucosal inflammatory infiltrates; granuloma-like infiltrates). In case of displacement, no significant changes of the previously stented bronchus occurred; and (3) Polyflex stents: no changes of the previously stented bronchi.

CONCLUSIONS

Gianturco stents proved unsafe in the long term, owing to the risk of severe airway wall damage. The Polyflex stent is well tolerated but presents a high migration rate. Silicone stents show several limitations but appear to be well tolerated by the host mucosa.

Lymphoepithelial cyst of the pancreas. Report of a case diagnosed by fine needle aspiration biopsy

BACKGROUND

Lymphoepithelial cysts of the pancreas are very rare lesions. To the best of our knowledge, 24 cases are reported in the literature.

CASE

A 64-year-old male presented with gastrointestinal complaints. A computed tomography scan of the abdomen disclosed a 55 x 30-mm, homogeneous mass anterior to and contiguous with the pancreas. Fine needle aspiration biopsy (FNAB) showed threads of tissue composed of stratified squamous epithelium with subepithelial lymphocytic infiltrate and keratinous material.

CONCLUSION

This case illustrates that FNAB is a rapid and reliable technique that can be used as the first diagnostic step in cases of cystic lesions of the pancreas. To our knowledge, this is the third case reported of this entity diagnosed with FNAB.

Fine needle aspiration biopsy of salivary gland, 1985-1995

OBJECTIVE

To evaluate the utility of fine needle aspiration biopsy (FNAB) in the study of salivary gland pathologies and to assess its capacity to provide an accurate diagnosis and discriminate between cases requiring surgery or not.

STUDY DESIGN

From January 1985 through December 1995, FNABs were carried out on 153 patients with salivary gland tumors. In 4 of the 153 cases the aspiration was inadequate. Of the remaining 149 FNAB diagnoses, 63 were checked histologically and 86 clinically.

RESULTS

Regarding the capacity to discriminate between neoplastic (malignant and benign) and nonneoplastic lesions FNAB correctly diagnosed 144 lesions (135 true negative [TN] and 9 true positive [TP]) and failed in 5 cases (false negative [FN]). Regarding the capacity to discriminate between tumors requiring surgery or not, the FNAB diagnoses were true in 146 cases (83 TP, 63 TN) and false in 3 (2 FN, 1 false positive). The values for sensitivity, specificity, negative predictive value and total diagnostic accuracy were 97.64%, 98.43%, 96.92% and 97.98%, respectively.

CONCLUSION

FNAB has an impact on the treatment of salivary gland masses. The data on its ability to distinguish between lesions requiring surgery or not are encouraging.

Fine needle aspiration biopsy diagnosis of a bone metastasis from an occult carcinoma of the liver. A case report

In a 66-year-old male, fine needle aspiration biopsy (FNAB) of an osteolytic vertebral lesion determined the diagnosis of a liver cell carcinoma, until then clinically silent. FNAB confirmed the diagnosis of the tumor and the identification of the primary site without resorting to surgery.

Fine needle aspiration biopsy in the diagnosis of intrathoracic masses

During a 3.5-year period (January 1, 1987, to June 30, 1990) 420 percutaneous fine needle aspiration (FNA) biopsies were performed on 390 patients (309 males, 81 females) suffering from one or more intrathoracic, radiologically visible lesions. Aspirations were carried out using 21- or 23-gauge Chiba needles under fluoroscopic or computed tomographic control. The aspirates were used to make minibiopsies and cytologic smears. Diagnosis was possible in 373 cases (95.64%): on the first pass in 344 cases, on the second in 28 cases and on the third in 1. In 17 cases (4.36%) the aspirate was inadequate for diagnosis. There were complications in 10 cases (2.56%) (9 pneumothorax and 1 hemophtysis) requiring intensive care. The 373 percutaneous FNA biopsy diagnoses included 256 malignant tumors (68.63%), of which 234 were primary and 22 were secondary, and 117 benign lesions (31.37%), 5 of them neoplastic and 112 nonneoplastic. Three hundred two of 373 percutaneous FNA biopsy diagnoses were followed (80.96%). One hundred twenty-three follow-ups were histologic (40.73%), including secondary tumors, which could be compared with the primary histotype. Twenty-eight follow-ups were cytologic (9.27%), and 151 were clinical (50.00%), using progression of the disease or the beginning of chemoradiotherapy as a criterion for malignancy and a stable condition or regression of the lesion with nononcologic medical treatment as a criterion for benignity. Percutaneous FNA biopsy diagnoses were confirmed in 288 cases (221 true positives and 67 true negatives) and unconfirmed in 14 (1 false positive and 13 false negatives). Specificity, sensitivity, negative predictive value, positive predictive value and total diagnostic accuracy were, respectively, 98.52, 94.44, 83.75, 99.54 and 95.36%. The histologic typing accuracy of percutaneous FNA biopsy on 70 specimens of surgically removed malignant epithelial neoplasias was 70.00%. These results confirm that percutaneous FNA biopsy is a reliable method of diagnosing intrathoracic masses and reduces the need for diagnostic thoracotomy.