RESUMEN
Papillary thyroid carcinoma (PTC) is a malignancy that has good prognosis especially among patients up to 45 years of age; about half of the patients are female and of childbearing age. Lymph node recurrence (LNR) occurs in 10%-14% of patients but is considered to be associated with relatively good prognosis. The purpose of this study was to estimate the association between patient age at primary operation, and the behavior of the disease after LNR. Between 1967 and 1994, 495 patients underwent surgery for primary PTC at the Department of Surgery, Helsinki University Central Hospital. There were 391 (79.0%) women and 104 (21.0%) men with a mean age of 44.5 years (range, 10.8-85.4 years). Fifty-eight patients in whom LNR was the first clinical sign of persistent disease after complete clinical response to primary treatment were included in this series. At the time of primary operation, 37 (64.3%) of the 58 patients who developed LNR were younger than 45 years of age and 21 patients were older. The mean times to LNR in these groups were 42.0 months (range, 3.0-194.5 months) and 49.0 months (range, 3.6-209.0 months) respectively. Carcinoma-specific 5-year survival after LNR was 100% (95% confidence interval [CI] 88.8%-100.0%) in patients ages up to 45 years and 61.1% (40.5%-82.8%) in older patients; 10-year survival rates were 100%, and 41.3% (p < 0.0001), respectively. Relative survival at 10 years was 98.6% for patients ages up to 45 years and 42.6% for older patients (p = 0.0014). Using the Cox model it was shown that development of LNR after primary treatment has an independent highly significant negative effect on survival (p < 0.001) in patients over 45 years of age. Prognosis of PTC even after LNR on patients ages up to 45 years at the time of the primary operation is almost parallel to the normal reference population, but in patients over 45 years of age the prognosis is relatively poor.
Asunto(s)
Carcinoma Papilar/secundario , Metástasis Linfática , Neoplasias de la Tiroides , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
Thyroid anaplastic (undifferentiated) carcinomas (TACs) comprise a morphologically heterogeneous group of tumors, which can arise in the background of differentiated papillary or follicular carcinoma. The thyroid epithelial differentiation varies in these tumors and has not been completely characterized. In this study, we immunohistochemically analyzed different variants TACs from 35 patients by using antibodies specific to 9 different keratin polypeptides, epithelial membrane antigen, thyroid transcription factor I (TTF-1), and thyroglobulin. These tumors were histologically divided into 3 categories: squamoid-cohesive (SC, 13 tumors), spindle cell sarcomatous (SS, 8 cases) and intermediate group, including tumors with giant cells and solid epithelioid components (GC, 18 tumors); 4 tumors had 2 components. The patients ages ranged from 40 to 89 years, with a mean age in all groups of 70 years. TTF-1 was present in only 2 of 9 of the SC tumors, and absent in all other TACs, but was present in entrapped differentiated components. Thyroglobulin was absent in all but 1 case. A complex keratin (K) pattern of stratified epithelia was typically seen in the SC tumors with extensive K7, K8, K17, K18, and K19, and variable K13 and K14 expression; EMA was also present. K16 was limited to squamous pearls in 1 tumor, and K10 was absent. The GC carcinomas typically had K8 and K18, whereas the expression of K7 was variable and that of K14, K17, and K19 sporadic; EMA was variably present in half of the cases. The keratins in spindle cell sarcomatous tumors were usually limited to K7, K8, and K18, often in limited numbers of cells. EMA was present in 1 case only. These results indicate a complex pattern of keratins in squamoid and giant cell TACs, similar to papillary carcinoma and suggesting the possibility of relationship. There was a progressive loss of epithelial differentiation and keratins in sarcomatoid TACs. Loss of TTF-1 is a nearly uniform feature of TAC and disallows the use of this marker to pinpoint a thyroid origin of these tumors.
Asunto(s)
Carcinoma/metabolismo , Queratinas/metabolismo , Proteínas Nucleares/metabolismo , Neoplasias de la Tiroides/metabolismo , Factores de Transcripción/metabolismo , Adenocarcinoma Folicular/metabolismo , Adenocarcinoma Folicular/patología , Anciano , Anciano de 80 o más Años , Carcinoma/clasificación , Carcinoma/patología , Carcinoma Papilar/metabolismo , Carcinoma Papilar/patología , Femenino , Técnica del Anticuerpo Fluorescente Directa , Humanos , Masculino , Persona de Mediana Edad , Tiroglobulina/metabolismo , Neoplasias de la Tiroides/clasificación , Neoplasias de la Tiroides/patología , Factor Nuclear Tiroideo 1RESUMEN
Analysis of most hematologic neoplasms indicates the involvement of one or more cell lineages in the bone marrow and/or the blood but rules out the involvement of all lineages in any one neoplasm. It is important to detect lineage involvement in order to clarify which stem cells are involved in leukemia, to predict prognosis, and to select appropriate treatment. Our aim was to study the cell lineage involvement of some of the recurrent chromosomal abnormalities seen in hematological neoplasms. The direct morphology-antibody-chromosomes (MAC) method was used. The deletion 20q in myeloproliferative diseases (MPD), the deletion of 5q and t(1;7) in myelodysplastic syndromes (MDS), and t(3;3) in acute myeloid leukemia subtype M7 (AML-M7) were seen in all or at least in two myeloid lineages. These were interpreted as stem cell abnormalities. Deletion 13q in MPD, t(8;21) in AML-M2 and t(15;17) in AML-M3 were seen in granulocytic lineages only; t(14;18) in non-Hodgkin's lymphoma and trisomy 12 as the sole abnormality in chronic lymphocytic leukemia (B-CLL) were seen only in immunoglobulin light chain clonal B cells; inversion 14 in T-CLL was seen only in T cells, whereas t(15;14) in acute lymphocytic leukemia with eosinophilia (ALL-EO) was seen in lymphoid stem cells but not in mature granulocytes or lymphocytes. Additional abnormalities (in addition to the Philadelphia chromosome) in chronic myeloid leukemia (CML) were seen in all myeloid cell lineages and also in mature granulocytes, B cells, and large granular lymphocytes. Abnormalities in Hodgkin's disease were restricted to CD30-positive Reed-Sternberg cells. Trisomy 8 and monosomy 7 are abnormalities that may be present in either stem cells or any of the single cell lineages.
Asunto(s)
Aberraciones Cromosómicas , Trastornos de los Cromosomas , Leucemia/genética , Linfoma/genética , Síndromes Mielodisplásicos/genética , Crisis Blástica/genética , Crisis Blástica/patología , Línea Celular , Deleción Cromosómica , Enfermedad de Hodgkin/genética , Humanos , Leucemia/patología , Linfoma/patología , Megacariocitos/patología , Células de Reed-Sternberg/patología , Células Madre/patología , Translocación Genética , Células Tumorales CultivadasRESUMEN
Two B-cell lines, designated as HF-1 and HF-4, were characterised. The cell lines have complicated karyotype abnormalities including a 14;18 translocation and an 8q24 breakpoint originating from t(2;8)(p11;q24) (HF-1) or t(1;8)(p21;q24) (HF-4). The lines have BCL2 rearrangement and they are positive for CD19, CD20, CD22, CD39. HF-1 is also positive for IgG, and HF-4 is positive for IgM and IgD. On Northern blot analyses, the 2.6-kb and 4.2-kb transcripts corresponding to the major transcripts of CMYC and BCL2, respectively, were seen. In Western blot as well as in FACS (fluorescence-activated cell sorting) analysis the presence of BCL2 protein in the both HF-1 and HF-4 cells was demonstrated. The cell lines are expected to serve as an important tool in the study of the chromosomal mechanism activating cellular oncogenes, the somatic hypermutation mechanism of antigen-activated B cells and the apoptosis of B cells.
Asunto(s)
Linfoma de Células B/patología , Secuencia de Bases , Cartilla de ADN/química , Expresión Génica , Reordenamiento Génico , Genes de Inmunoglobulinas , Genes myc , Humanos , Inmunofenotipificación , Cariotipificación , Ganglios Linfáticos/patología , Datos de Secuencia Molecular , Oncogenes , Proteínas Proto-Oncogénicas/genética , Proteínas Proto-Oncogénicas c-bcl-2 , ARN Mensajero/genética , Translocación Genética , Células Tumorales CultivadasRESUMEN
All cases of gastrointestinal (GI) non-Hodgkin's lymphoma diagnosed in Finland between 1972 and 1977 were histologically reexamined and immunostained in order to study the value of histological classification. One hundred and eleven cases were found. The crude annual incidence was 0.51/10(5) and the age-adjusted (world standard population) incidence 0.23/10(5). The male-to-female ratio of age-adjusted incidence rates was 2.7. The most common histological type was large B-cell lymphoma comprising 61% of all classifiable cases. Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma comprised 12%, centrocytic lymphoma 9%, peripheral T-cell lymphoma 9%, Burkitt's lymphoma 7% and large-cell anaplastic lymphoma 3% of the total. In the jejunum, almost one half of the cases were T-cell lymphomas and there were no lymphomas with definite MALT features. Gastric lymphomas had higher survival rates than intestinal lymphomas, B-cell lymphomas slightly higher survival rates than T-cell lymphomas, and low-grade MALT lymphomas higher survival rates than other B-cell lymphomas. The other types of lymphomas differed only slightly from each other in prognosis. The histological grade according to the Working Formulation correlated with survival rates, but a great majority of cases were classified as intermediate grade. Classification of GI lymphomas into the types mentioned above appears to correlate with several clinical and pathological parameters.
Asunto(s)
Neoplasias Gastrointestinales/patología , Linfoma no Hodgkin/patología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Linfoma de Burkitt/epidemiología , Linfoma de Burkitt/patología , Femenino , Estudios de Seguimiento , Neoplasias Gastrointestinales/clasificación , Neoplasias Gastrointestinales/epidemiología , Humanos , Inmunofenotipificación , Incidencia , Linfoma Anaplásico de Células Grandes/epidemiología , Linfoma Anaplásico de Células Grandes/patología , Linfoma no Hodgkin/epidemiología , Linfoma de Células T/epidemiología , Linfoma de Células T/patología , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores Sexuales , Análisis de SupervivenciaRESUMEN
Tumors from 48 patients with non-Hodgkin's lymphoma were examined for flow cytometric DNA ploidy and chromosome constitution to determine the degree of concordance of these two methods. Histologically, there were 24 low-grade, 19 intermediate, and 5 high-grade lymphomas. Flow cytometry revealed an aneuploid cell population in 19% of the cases. The mean DNA index of the aneuploid tumors was 1.58 +/- 0.71. The frequency of DNA aneuploidy was only slightly higher (23%) in intermediate than in low-grade lymphomas (17%). None of the five high-grade lymphomas showed DNA aneuploidy. The chromosome study was successful in 81% of cases (39 of 48), and clonal chromosome abnormalities were observed in 92% of these (36 of 39). In most of the chromosomally abnormal clones the chromosome number was in the diploid range. Most tumors with pseudodiploid (46 chromosomes), hypodiploid (45-44 chromosomes), or hyperdiploid (47-49 chromosomes) clones were DNA diploid by flow cytometry. On the other hand, all specimens with a chromosome number exceeding 50 were DNA aneuploid by flow cytometry. Therefore, flow cytometric DNA analysis appears to be a rather coarse method that will detect aneuploidy only when there is a major increase in chromosome material.
Asunto(s)
Aneuploidia , ADN de Neoplasias/genética , Linfoma no Hodgkin/genética , Adulto , Anciano , Anciano de 80 o más Años , Aberraciones Cromosómicas/genética , Trastornos de los Cromosomas , Femenino , Citometría de Flujo , Humanos , Cariotipificación , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , PloidiasRESUMEN
The new, age-related TNM classification system of papillary thyroid carcinoma was applied in a retrospective analysis of 199 patients operated on during the 24-year period from 1956 through 1979 at the Second Department of Surgery, Helsinki University Central Hospital. According to the new staging system, 103 patients (under 45 years of age) and 96 T1 patients (45 years of age and older) were categorized into stage I. The incidence of carcinoma-positive cervical lymph nodes was highest among patients under 30 years of age at primary surgery. During the follow-up period of 6-29 years, cervical lymph node involvement was verified at reoperation in 20 patients (10%). Distant metastases (bone or lung) developed in 11 patients (5.5%). Thirty-one patients (16%) died from carcinoma. The prognostic value of stage grouping, in terms of metastatic tendency and cancer mortality, was clearly demonstrated in the present material, suggesting the suitability of this simplified, new, age-related staging system in clinical practice.
Asunto(s)
Carcinoma Papilar/clasificación , Neoplasias de la Tiroides/clasificación , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma Papilar/mortalidad , Carcinoma Papilar/secundario , Carcinoma Papilar/cirugía , Niño , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/cirugíaRESUMEN
Immunoscintigraphy with 99Tcm-labelled anti-melanoma monoclonal antibody F(ab')2- fragments was performed in 23 patients with histologically verified metastatic melanoma. Immunoscintigraphy was positive in 14 patients and all known metastases were detected in eight patients, five of whom had only one lesion. Lesion localization and detectability were as follows: 12/13 (92%) cutaneous and subcutaneous, 11/14 (79%) lymph node, 5/7 (71%) bone, 3/6 (50%) lung and 1/5 (20%) abdominal metastases were visualized. Despite its high specificity--no false positive immunoscintigrams--the low sensitivity of this method in detecting deep metastases hampers its usability. The false negative results were not due to lack of antigen expression as positive immunostaining results were observed also in specimens from patients with negative immunoscintigrams. Flow cytometric analysis of the metastases revealed that in 7/8 (88%) patients with diploid tumours had positive immunoscintigrams but only 7/15 (47%) patients with aneuploid tumours. These results show that the diagnostic accuracy of melanoma immunoscintigraphy can be improved by selecting patients not only by testing for the antigen but also on the basis of DNA analysis of an accessible lesion.
Asunto(s)
Anticuerpos Monoclonales , Melanoma/secundario , Neoplasias Abdominales/diagnóstico por imagen , Neoplasias Abdominales/inmunología , Neoplasias Abdominales/secundario , Adulto , Anciano , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/inmunología , Neoplasias Óseas/secundario , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/inmunología , Neoplasias Pulmonares/secundario , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/inmunología , Masculino , Melanoma/diagnóstico por imagen , Melanoma/inmunología , Persona de Mediana Edad , Cintigrafía , Sensibilidad y Especificidad , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/inmunología , Neoplasias Cutáneas/secundario , TecnecioRESUMEN
The usefulness of low-molecular-weight B-cell growth factor (LMW-BCGF) for routine cytogenetic study of B cell non-Hodgkin lymphomas (NHL) was evaluated. Eighteen B cell lymphoma specimens were cultured for 4 days in the presence or absence of LMW-BCGF. After culture, conventional cytogenetic analysis was carried out, and the Morphology Antibody Chromosomes (MAC) method was used to study the frequencies of mitotic cells in different lymphocyte subsets. Our results showed that in 6 of the 14 lymphomas with a chromosomally abnormal clone LMW-BCGF produced an increased frequency of abnormal mitosis. In eight cases, LMW-BCGF did not increase, or even decrease, the frequency of karyotypically abnormal mitoses. In these eight cases, the total number of mitosis was often increased, but the mitotic cells were shown to be T cells. LMW-BCGF seems to have a clearly favorable effect on the cytogenetics of some B cell NHL, but apparently it is not a radical improvement over the routine techniques now being used.
Asunto(s)
Aberraciones Cromosómicas , Linfocinas/farmacología , Linfoma no Hodgkin/genética , Adulto , Anciano , Anciano de 80 o más Años , División Celular/efectos de los fármacos , Femenino , Humanos , Linfocitos/efectos de los fármacos , Linfocitos/inmunología , Linfocitos/patología , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Mitosis/efectos de los fármacos , Fenotipo , Células Tumorales Cultivadas/efectos de los fármacos , Células Tumorales Cultivadas/patologíaRESUMEN
Three patients with T-cell lymphoma were studied with a combined cytogenetic-immunological analysis (MAC) as well as by Southern blotting analysis. The MAC method, which allows simultaneous study of both chromosomes and immunophenotype of a mitotic cell, revealed that in each case the karyotypically abnormal and, therefore, neoplastic cells originated from different stages of T-cell maturation. In one case the abnormality was seen in cells expressing CD3 and CD10, in the second in cells expressing CD3 and CD8, and in the third case in cells expressing CD4 but not CD3. Mitoses were frequent also in non-neoplastic cells, but these mitoses were normal. Southern blotting analysis revealed TCR beta rearrangements in all patients. In addition, one patient displayed TCR gamma rearrangement, and one patient a rearrangement in the IgH joining region.
Asunto(s)
Antígenos de Neoplasias/análisis , Linfoma/genética , Linfocitos T/fisiología , Anciano , Southern Blotting , Niño , Femenino , Humanos , Técnicas para Inmunoenzimas , Interfase , Cariotipificación , Linfoma/inmunología , Linfoma/patología , Masculino , Persona de Mediana Edad , MitosisRESUMEN
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)
Asunto(s)
Adenocarcinoma/terapia , Neoplasias de la Tiroides/terapia , Adenocarcinoma/patología , Adolescente , Carcinoma Papilar/patología , Carcinoma Papilar/terapia , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Radioisótopos de Yodo/uso terapéutico , Masculino , Pronóstico , Neoplasias de la Tiroides/patología , TiroidectomíaRESUMEN
A series of 47 primary and seven metastatic thyroid follicular carcinomas, including well, moderately and poorly differentiated, were tested for thyroglobulin (Tg) using immunohistology. In addition, three combined follicular undifferentiated carcinomas, 17 undifferentiated carcinomas and five renal cell carcinomas metastatic to the thyroid were examined. Only two follicular carcinomas did not stain for thyroglobulin. Some inter-tumour differences in Tg staining were found but there was no absolute correlation between this and the degree of tumour differentiation. The two tumours that failed to stain for Tg were poorly differentiated; thyroglobulin positive poorly differentiated tumours demonstrated a clearly weaker staining pattern for Tg. All but one of 15 oxyphilic follicular carcinomas stained positively for Tg but the staining intensity was often weak. Five of six clear cell follicular carcinomas were positive for Tg but the staining reaction was generally faint and there were often large areas devoid of positive cells. Positive staining was demonstrated in the differentiated areas of combined follicular undifferentiated carcinomas. Undifferentiated carcinomas and metastatic renal cell carcinomas gave negative results. Thyroglobulin is a reliable marker for thyroid follicular carcinoma but the patchy staining pattern, particularly in the less well-differentiated tumours may produce less reliable results in small biopsies.
Asunto(s)
Adenocarcinoma/análisis , Biomarcadores de Tumor/análisis , Transformación Celular Neoplásica/patología , Tiroglobulina/análisis , Neoplasias de la Tiroides/análisis , Adenocarcinoma/patología , Humanos , Técnicas para Inmunoenzimas , Neoplasias de la Tiroides/patologíaRESUMEN
A new method of preparing smears of alcohol-fixed cytologic material by using methacrylate embedding medium to make the cells adhere on plain glass slides is presented. After centrifugation, the cytologic material was mixed with Lowicryl K4M embedding medium and smeared on slides. The polymerization process was achieved by exposing the slides to ultraviolet light. The morphology in such smears was similar to that of specimens prepared by the filter technique. The methacrylate method does not have the most common disadvantages of the filter technique--the development of air bubbles over time and the visually disturbing presence of the filter.
Asunto(s)
Acrilatos , Técnicas Citológicas , Metacrilatos , Adhesión Celular , Vidrio , Humanos , Neoplasias Hepáticas/patología , Polímeros , Coloración y EtiquetadoRESUMEN
6 cases of different lymphoproliferative diseases were studied with the new MAC (Morphology-Antibody-Chromosome) method in order to find out 1) if the abnormal karyotype is confined to the monoclonal cell population, 2) if there are, within this clone, also cells with a normal karyotype, and 3) if the method can help the pathologist to diagnose malignant lymphoproliferative diseases. The MAC method allows a simultaneous study in the same metaphase cell of the karyotype, surface markers, and some morphological features. In all cases in which a monoclonal cell proliferation was detected immunohistologically, the MAC examination showed a chromosomal abnormality for the same light chain as was detected in immunohistology, but not in other cells. In all but a single case, all mitotic cells belonging to the clonal cell proliferation had an abnormal karyotype. In this case with lambda clonality, 2/8 lambda-positive mitoses had a normal karyotype. However, all the normal mitoses occurred in small lymphocytes whereas the abnormal mitoses were seen in large blastic cells. In 1 case, the MAC method helped in confirming the diagnosis of malignant lymphoma (nodular small cleaved cell type). Especially in lymphomas composed of a mixed cell population, the MAC method makes it possible to find out which cell types have an abnormal karyotype and which have a normal karyotype.
Asunto(s)
Aberraciones Cromosómicas , Trastornos Linfoproliferativos/genética , Adulto , Anciano , Femenino , Humanos , Cariotipificación , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/patología , Masculino , Persona de Mediana EdadRESUMEN
All cases diagnosed in Finland as non-Hodgkin's lymphoma (NHL), Hodgkin's disease or histiocytosis X in children younger than 15 years in 1953 to 1973, according to the Finnish Cancer Registry, were reexamined histologically. Only 55% of the cases originally diagnosed as NHL were regarded as such at reexamination. The others were mainly malignant nonlymphatic tumors such as neuroblastoma and different kinds of sarcomas. Seventy-two NHLs were diagnosed in 50 boys and 22 girls. The corrected age-specific incidence rate was 0.32/10(5). The most common histologic types were Burkitt's lymphoma (BL) (30 cases), lymphoblastic lymphoma (LBL) (26), large cell lymphomas (LCL) (six), and non-Burkitt's lymphoma (n-BL) (three). There were marked differences between BL and LBL in the course of the disease: BL was extranodal in 83%, LBL only in 4% (mediastinum was regarded as nodal); BL showed initial abdominal or pelvic involvement in 60% whereas LBL showed none; BL had initial mediastinal involvement in 7%, and LBL had it in 62%; all patients with LBL died whereas 23% of those with BL survived. Other types of NHL resembled BL in their course of disease. Patients with initial tonsillary involvement appeared to have the best prognosis and patients with mediastinal involvement the poorest. The importance of accurate histologic classification is emphasized. It appears to be most important to differentiate LBL from other types of NHL.
Asunto(s)
Linfoma no Hodgkin/epidemiología , Análisis Actuarial , Adolescente , Linfoma de Burkitt/patología , Niño , Preescolar , Errores Diagnósticos , Femenino , Finlandia , Histiocitosis de Células de Langerhans/patología , Enfermedad de Hodgkin/patología , Humanos , Lactante , Linfoma no Hodgkin/mortalidad , Linfoma no Hodgkin/patología , Masculino , Sistema de RegistrosRESUMEN
The thyroids from 93 autopsies performed on children and young adults younger than age 40 years, were subserially sectioned at 2- to 3-mm intervals. Thirteen thyroids revealed 17 foci of occult papillary carcinoma (OPC), giving a prevalence rate of 14%. The youngest affected patient was a boy aged 18 years. The prevalence rate of individuals between age 18 and 40 years was 27%. The rate appears to be rather constant in adults, although there may be a slight rise in middle age. The prevalence rate was higher for males, but no statistically significant difference was seen. The arise of OPCs after puberty would favor the view that hormonal factors are related to their appearance.
Asunto(s)
Carcinoma Papilar/epidemiología , Neoplasias de la Tiroides/epidemiología , Adolescente , Adulto , Factores de Edad , Carcinoma Papilar/patología , Niño , Preescolar , Femenino , Finlandia , Humanos , Lactante , Masculino , Factores Sexuales , Glándula Tiroides/patología , Neoplasias de la Tiroides/patologíaRESUMEN
The thyroids from 101 consecutive autopsies from Finland were subserially sectioned at 2- to 3-mm intervals. From 36 thyroids, 52 foci of occult papillary carcinoma (OPC) were found, giving a prevalence rate of 35.6%, the highest reported rate in the world. The rate was higher, although not significantly, in males (43.3%) than in females (27.1%), but it did not correlate to the age of the patients. Twenty-six glands contained one tumor focus and ten glands contained two to five tumor foci. Only a minority of the smallest tumors can be detected with the method used. The probable number of OPCs over 0.15 mm in diameter was calculated to be about 300 in this material. The tumor diameter varied from 0.15 mm to 14.0 mm, with 67% of tumors under 1.0 mm. The smallest tumors were usually circumscribed and were composed almost solely of follicles. Larger tumors had more papillary structures and were often invasive. Fibrosis and, in the largest OPCs, lymphocytic reaction were seen around the invasive islands. All tumors were positively stained for thyroglobulin and all but one of the tumors stained positively for epidermal keratin. OPC appears to arise from follicular cells of normal follicles. Apparently the great majority of the tumors remain small and circumscribed and even from those few tumors that grow larger and become invasive OPCs only a minimal proportion will ever become a clinical carcinoma. According to the study, OPC can be regarded as a normal finding which should not be treated when incidentally found. In order to avoid unnecessary operations it is suggested that incidentally found small OPCs (less than 5 mm in diameter) were called occult papillary tumor instead of carcinoma.
Asunto(s)
Carcinoma Papilar/patología , Neoplasias de la Tiroides/patología , Adolescente , Adulto , Anciano , Carcinoma Papilar/mortalidad , Niño , Preescolar , Estudios Transversales , Femenino , Finlandia , Humanos , Lactante , Queratinas/metabolismo , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/patología , Glándula Tiroides/patología , Neoplasias de la Tiroides/mortalidadRESUMEN
An apparently new tumor entity of the thyroid is reported. The tumor was histologically characterized by good demarcation, lobular pattern, keratin-positive spindle cells, glandular elements, stromal hyalinization, and calcifications. These findings are suggestive of a tumor related to spindle-cell thymoma and apparently closely related to the recently described entity, ectopic hamartomatous thymoma. The patient, a 23-year-old man is alive and well 10 years after diagnosis. Two histologically similar cases have earlier been reported in the English literature under the heading "malignant teratoma."
Asunto(s)
Quistes/patología , Timoma/patología , Neoplasias de la Tiroides/patología , Adulto , Niño , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Teratoma/diagnósticoRESUMEN
The workshop participants agreed on the following points regarding follicular carcinoma: Follicular carcinoma should be divided into two groups according to its degree of invasion: encapsulated and widely invasive. Patients in the first group only occasionally develop distant metastases, whereas in the second group the prognosis is much poorer. In encapsulated follicular tumors, high cellularity and nuclear atypia should not be used as criteria of malignancy; this diagnosis should be based on the presence of vascular or capsular invasion. Only tumor thrombi occurring in vessels in or outside the capsule should be regarded as indicative of vascular invasion. Capsular invasion should be diagnosed only if penetration of the whole capsule is seen. We agree that some tumor islands within the capsule may represent true tumor invasion, but we believe that some others may be due to capsular infoldings or tangential sectioning. Whenever tumor tissue within the capsule is seen, additional tissue blocks from the capsular area should be processed in a search for capsular penetration or vascular invasion. The degree of differentiation in follicular carcinoma does not correlate to the course of disease as clearly as the degree of invasion, although the so-called insular or poorly differentiated, subtype seems to have a poorer prognosis. Thyroid carcinomas composed of large eosinophilic cells (Hürthle cell carcinomas) usually show follicular differentiation and are therefore included in the category of follicular carcinoma. The same diagnostic criteria of malignancy that apply for other follicular tumors should be used when evaluating these tumors. Although follicular carcinomas often show foci of clear cells, tumors composed solely of clear cells are rare. Most pure clear-cell tumors in the thyroid represent metastatic tumors, usually from the kidney. In the distinction of follicular carcinoma from papillary carcinoma, all differential diagnostic criteria should be used. However, in some cases, the diagnosis can be based on one criterion only, mainly the presence of widespread ground-glass nuclei or abundant neoplastic papillae in papillary carcinoma. The presence of occasional papillae in encapsulated tumors composed of large eosinophilic cells is not sufficient for the diagnosis of papillary carcinoma if the other microscopic features of this tumor are lacking.
Asunto(s)
Adenocarcinoma/patología , Neoplasias de la Tiroides/patología , Adenocarcinoma/irrigación sanguínea , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Células Neoplásicas Circulantes , Glándula Tiroides/irrigación sanguíneaRESUMEN
Clinical and morphological features of three cases of primary mucoepidermoid carcinoma of the thyroid are described. The tumours were composed of two cell types. One of these resembled squamous epithelium and ultrastructurally showed tonofilaments and numerous desmosomes. The other cell type contained Alcian blue and mucicarmine positive mucin and, on electron microscopy, showed mucigen granules. Marked stromal fibrosis and psammoma bodies were seen in all tumours. Immunohistochemical studies showed that the tumour cells were negative for thyroglobulin. A few calcitonin-containing cells were seen in one metastatic tumour. One tumour showed, in addition to the histological features of mucoepidermoid carcinoma, anaplastic areas with obvious transition between the two histological patterns. The same thyroid also had a small thyroglobulin-positive papillary carcinoma in the opposite lobe. All tumours presented lymph node metastases. In two cases the primary tumour was confined within the thyroid capsule but that with anaplastic areas invaded surrounding structures. This patient died 13 months after diagnosis; the other patients are alive and symptomless one and 10 years since diagnosis. Mucoepidermoid carcinoma of the thyroid appears to be a clinicopathological entity that resembles papillary carcinoma in its natural history. The origin of the tumour is unclear. There is, however, some histological and immunohistological data suggesting that the tumour might be related to the ultimobranchial system although some histological features also appear to favour a common origin with papillary carcinoma.