RESUMO
BACKGROUND: During the detection of neck recurrence in patients with Papillary Thyroid Carcinoma (PTC), sometimes it is difficult to distinguish metastatic from inflammatory neck lymph nodes. The measurement of serum thyroglobulin (sTg) under thyroid hormone suppression therapy the presence of serum thyroglobulin antibodies (sAbTg), the diagnostic whole body scan and cytology can give false negative results. Measurement of thyroglobulin in the washout fluid from fine-needle aspiration biopsy (FNAB) of suspicious neck lymph nodes could improve the diagnostic accuracy. AIM: To evaluate the usefulness of detecting Tg in lymph nodes (LTg) suspicious by ultrasonography (US) and compare it to cytology. PATIENTS AND METHODS: Between the years 2004 and 2007 we prospectively studied 30 patients with PTC and cervical US findings of suspicious recurrence. LTg was assayed in US guided FNAB used for cytology. RESULTS: Sixteen out of 30 patients underwent surgery using as selective criteria an LTg higher than sTg or a positive cytology. Surgery confirmed the presence of metastasis in all 15 patients with positive LTg (8 with positive cytology) and in 1 patient with negative LTg and positive cytology (a case with undifferentiated thyroid cancer). The sensitivity was 93.7% for LTg and 56.2% for cytology. We identified by LTg 3 of 6 patients with undetectable sTg and positive sAbTg. CONCLUSIONS: The presence of LTg showed a higher sensitivity than cytology for the detection of cervical lymph node metastasis. This method is useful even in the presence of sAbTg.
Assuntos
Biomarcadores Tumorais/análise , Carcinoma Papilar/patologia , Tireoglobulina/análise , Neoplasias da Glândula Tireoide/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Biópsia por Agulha Fina , Carcinoma Papilar/química , Carcinoma Papilar/secundário , Reações Falso-Negativas , Feminino , Seguimentos , Humanos , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Estudos Prospectivos , Sensibilidade e Especificidade , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/química , Adulto JovemRESUMO
Background: During the detection ofneck recurrence in patients with Papillary Thyroid Carcinoma (PTC), sometimes it is difficult to distinguish metastatic from inflammatory neck lymph nodes. The measurement of serum thyroglobulin (sTg) under thyroid hormone suppression therapy the presence of serum thyroglobulin antibodies (sAbTg), the diagnostic whole body sean and cytology can give false negative results. Measurement of thyroglobulin in the washout fluid from fine-needle aspiration biopsy (FNAB) of suspicious neck lymph nodes could improve the diagnostic aecuracy Aim: To evaluate the usefulness of detecting Tg in lymph nodes (LTg) suspicious by ultrasonography (US) and compare it to cytology. Patients and Methods: Between the years 2004 and 2007 we prospectively studied 30 patients with PTC and cervical US findings of suspicious recurrence. LTg was assayed in US guided FNAB used for cytology. Results: Sixteen out of 30 patients underwent surgery using as selective criteria an LTg higher than sTg or a positive cytology. Surgery confirmed the presence of metástasis in all 15 patients with positive LTg (8 with positive cytology) and in 1 patient with negative LTg and positive cytology (a case with undifferentiated thyroid cancer). The sensitivity was 93.7 percent for LTg and 56.2 percent for cytology. We identified byLTg 3 of 6 patients with undetectable sTg and positive sAbTg. Conclusions: The presence of LTg showed a higher sensitivity than cytology for the detection of cervical lymph node metástasis. This method is useful even in the presence ofsAbTg.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Carcinoma Papilar/patologia , Tireoglobulina/análise , Neoplasias da Glândula Tireoide/patologia , Biomarcadores Tumorais/análise , Biópsia por Agulha Fina , Carcinoma Papilar/química , Carcinoma Papilar/secundário , Reações Falso-Negativas , Seguimentos , Linfonodos/patologia , Metástase Linfática/patologia , Pescoço/patologia , Estudos Prospectivos , Sensibilidade e Especificidade , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/química , Biomarcadores Tumorais/sangue , Adulto JovemRESUMO
We report a case of Papillary carcinoma with nodular fasciitis-like stroma that is a rare variant of Papillary carcinoma characterized by a prominent stromal cell proliferation that causes difficulties in cytologic and histologic diagnosis. The patient was a 34-year-old woman, pregnant, presented with a 1-year history of a growing mass in neck, dysphagia, and hoarseness. Physical examination revealed a firm nodular mass in thyroid gland. The fine needle aspiration biopsy specimen contained, besides diagnostic epithelial features of Papillary thyroid carcinoma, discohesive arrangement of bland spindle cells. Macroscopically, the specimen consisted of nodular tumor measuring 10 x 6 x 6 cm. Histologically the tumor was composed of small foci of neoplastic epithelial component distributed in abundant stroma. In immunohistochemistry, spindle cells in the stroma were positive for alpha-smooth muscle actin and the neoplastic cells showed positive staining for TTF-1 and progesterone receptor.
Assuntos
Carcinoma Papilar/patologia , Fasciite/patologia , Complicações Neoplásicas na Gravidez , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Actinas/análise , Adulto , Biomarcadores Tumorais/análise , Biópsia por Agulha Fina , Carcinoma Papilar/química , Carcinoma Papilar/cirurgia , Feminino , Humanos , Técnicas Imunoenzimáticas , Gravidez , Receptores de Progesterona/análise , Células Estromais/patologia , Neoplasias da Glândula Tireoide/química , Neoplasias da Glândula Tireoide/cirurgia , Resultado do TratamentoRESUMO
Papillary neoplasms of the breast represent a complex spectrum ranging from benign to malignant lesions. The myoepithelial cell (MEC) layer is generally continuous in papillomas and increasingly discontinuous to absent in atypical and malignant counterparts. Identification of MECs can be difficult on morphological grounds and currently relies on immunomarkers. We investigated the potential role of p63 and CD10 in 20 papillary lesions and compared them with 1A4 and calponin. In 18 cases, adjacent normal breast tissue was available for study. All four markers were diffusely positive in all samples of normal tissue and benign papillomas indicating similar sensitivity in the identification of MECs. Intense positivity was found in 100% of the cases with 1A4 and CD10, but in only 76% with calponin and in 60.5% with p63 (differences statistically significant, p < 0.05), suggesting that the former two render more reproducible results. The most specific markers were p63 and CD10 which showed cross-reactivity in 0% and in up to 33% of the cases respectively. 1A4 and calponin showed diffuse cross-reactivity in all cases. When assessing benign versus atypical papillomas, the best parameters were diffuse positivity using CD10 or p63, and continuous MEC layer, mainly using CD10. When comparing benign papillomas to carcinomas all parameters were equally useful with 1A4 and CD10. Regardless of the marker, intense positivity was the only parameter that could distinguish atypical papillomas from papillary carcinomas. p63 staining, which renders a nuclear and mostly discontinuous reactivity, was not as useful as the other markers when the parameter continuous MEC layer was evaluated. Although CD10 seems to combine the highest specificity and reproducibility with a good sensitivity, reproducibility of 1A4 is higher. Thus, a minimum panel to assess papillary lesions should include both markers. Although p63 is the most specific, its nuclear and discontinuous pattern may lead to erroneous diagnosis, especially in the differentiation between benign papillomas and atypical/malignant lesions.
Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Mama/patologia , Carcinoma Papilar/patologia , Proteínas de Membrana/análise , Neprilisina/análise , Neoplasias da Mama/química , Neoplasias da Mama/metabolismo , Proteínas de Ligação ao Cálcio/análise , Carcinoma Papilar/química , Carcinoma Papilar/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Proteínas dos Microfilamentos/análise , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , CalponinasRESUMO
BACKGROUND: Solid pseudopapillary neoplasm of the pancreas is a distinctive pancreatic neoplasm with low metastatic potential. This study examines clinical differences and prognosis between male and female patients. METHODS: The medical records of 34 consecutive patients with pancreatic solid pseudopapillary neoplasms between 1990 and 2006 were reviewed. Whenever feasible, organ-preserving operation was performed. Statistical analysis was performed using chi-square and Student t test. RESULTS: There were 27 women (79%) and seven men (21%) with median age of 23 years. Mean diameter of the tumor was 7 cm. Tumor size tended to be smaller in patients treated in more recent years. Conservative surgery was possible in 11 patients including spleen-preserving distal pancreatectomy in 3, central pancreatectomy in 5, and enucleation in 3 patients. Median hospital stay was 11 days, morbidity rate was 62%, including 17 patients with grade A pancreatic fistula, and there was no operative mortality. Mean follow-up time was 84 months. Tumor recurred in 2 patients (6%). Overall late morbidity rate was 12%. At the time of diagnosis, age was (x +/- SD) higher among male patients (25 +/- 2 years vs 37 +/- 7 years; P <.05) with no difference in tumor size. The neoplasms were more aggressive in male patients; therefore, conservative surgery was less likely. There was no correlation between tumor aggressiveness and age of the patient or size of tumor. CONCLUSION: This is the first single center study to demonstrate that solid pseudopapillary neoplasms in male patients have distinct patterns of onset and aggressiveness when compared with female patients. Although valid prognostic criteria are still lacking, it appears that male patients may be best treated by more radical operation and should be observed more closely during follow-up.
Assuntos
Carcinoma Papilar/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Fatores Sexuais , Adolescente , Adulto , Idoso , Biomarcadores Tumorais/análise , Carcinoma Papilar/química , Carcinoma Papilar/cirurgia , Criança , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Pancreatectomia , Neoplasias Pancreáticas/química , Neoplasias Pancreáticas/cirurgia , Prognóstico , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Type I iodothyronine deiodinase (D1) catalyses the 5' monodeiodination of T4 and is highly expressed in normal human thyroid gland. We have investigated D1 expression in a series of benign and malignant differentiated thyroid neoplasias. DESIGN: Surgically isolated thyroid tumour fragments were used. D1 expression was determined by reverse transcription polymerase chain reaction (RT-PCR) and enzymatic assay. PATIENTS: Tumours and adjacent normal tissues were obtained from 28 unselected patients (papillary carcinoma, n = 14; follicular adenoma, n = 7; follicular carcinoma, n = 6; anaplastic carcinoma, n = 1). MEASUREMENTS: D1 mRNA levels were determined using specific primers for the human D1 gene and enzymatic assays were performed using T4 as substrate. RESULTS: In papillary thyroid carcinoma (PTC), D1 mRNA and activity levels were decreased compared with the surrounding tissue (0.25 +/- 0.24 vs. 1.09 +/- 0.54 arbitrary units (AU), P < 0.001 and 0.08 +/- 0.07 vs. 0.24 +/- 0.15 pmol T4/min/mg protein, P = 0.045, respectively). Decreased D1 expression was consistent and was observed in all histological subtypes and clinical stages analysed, including microcarcinomas. By contrast, significantly higher D1 mRNA levels and enzyme activity were present in follicular adenoma (1.9 +/- 1.5 vs. 0.83 +/- 0.58 AU, P = 0.028 and 2.67 +/- 1.42 vs. 0.22 +/- 0.06 pmol T4/min/mg protein, P = 0.044, respectively) and in follicular thyroid carcinoma (FTC) than in surrounding normal tissue (1.2 +/- 0.46 vs. 0.67 +/- 0.18 AU, P = 0.038 and 1.20 +/- 0.58 vs. 0.20 +/- 0.10 pmol T4/min/mg protein, P < 0.001, respectively). Type II iodothyronine deiodinase (D2) activity was also significantly higher in metastatic FTC samples than in normal thyroid tissues (5.20 +/- 0.81 vs. 0.30 +/- 0.27 fmol T4/min/mg protein, P < 0.001). CONCLUSIONS: These findings suggest that thyroid cell dedifferentiation promotes changes in D1 gene expression by pretranscriptional mechanisms and indicate that decreased D1 expression might be an early and discrete event in thyroid cell dedifferentiation towards papillary thyroid carcinoma.
Assuntos
Biomarcadores Tumorais/química , Carcinoma Papilar/química , Iodeto Peroxidase/análise , Neoplasias da Glândula Tireoide/química , Adenoma/química , Adulto , Idoso , Carcinoma/química , Carcinoma Papilar, Variante Folicular/química , Feminino , Humanos , Iodeto Peroxidase/genética , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
BACKGROUND: Nodular thyroid disease is a very common disorder with a low frequency of malignancy. The most accurate diagnostic test is fine needle aspiration biopsy (FNAB) of nodules with cytological analysis of the sample. However, this procedure has some limitations in the diagnosis of follicular and papillary thyroid carcinoma. AIM: To detect mRNA from specific malignancy markers in thyroid nodules and to evaluate their potential correlation with cytological and pathological diagnosis. PATIENTS AND METHODS: In 20 patients with thyroid nodules FNAB was performed prior to surgery. The main part of the FNAB sample was used to perform classical cytology. In the remaining of the sample were detected MUC-1, CD26, galectin-3 and TSH receptor mRNAs by RT-PCR technique. RESULTS: Eight patients had positive cytology for papillary cancer, which was confirmed by pathology. Nine had suspicious or non conclusive cytological findings and 3 were negative for neoplastic cells; all 12 were pathologically benign. We detected TSH receptor and galectin-3 mRNA in almost all benign and malignant nodules. MUC-1 was present in 5/8 papillary carcinoma (62.5%), and 1/12 benign nodules (8.3%). CD26 was detected in 7/8 papillary carcinomas but also in 8/12 benign nodules. CONCLUSIONS: RT-PCR can be performed in very small samples of thyroid tissue to detect several mRNA markers. MUC-1 can be a potentially useful marker of malignancy in thyroid nodules. It can be detected by RT-PCR as a complementary technique in the diagnostic evaluation of thyroid nodules.
Assuntos
Biomarcadores Tumorais/análise , Carcinoma Papilar/química , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Nódulo da Glândula Tireoide/química , Biópsia por Agulha Fina , Carcinoma Papilar/patologia , Eletroforese em Gel de Ágar , Humanos , Estudos Prospectivos , RNA Mensageiro/análise , Nódulo da Glândula Tireoide/patologiaRESUMO
BACKGROUND: Nodular thyroid disease is a very common disorder with a low frequency of malignancy. The most accurate diagnostic test is fine needle aspiration biopsy (FNAB) of nodules with cytological analysis of the sample. However, this procedure has some limitations in the diagnosis of follicular and papillary thyroid carcinoma. AIM: To detect mRNA from specific malignancy markers in thyroid nodules and to evaluate their potential correlation with cytological and pathological diagnosis. PATIENTS AND METHODS: In 20 patients with thyroid nodules FNAB was performed prior to surgery. The main part of the FNAB sample was used to perform classical cytology. In the remaining of the sample were detected MUC-1, CD26, galectin-3 and TSH receptor mRNAs by RT-PCR technique. RESULTS: Eight patients had positive cytology for papillary cancer, which was confirmed by pathology. Nine had suspicious or non conclusive cytological findings and 3 were negative for neoplastic cells; all 12 were pathologically benign. We detected TSH receptor and galectin-3 mRNA in almost all benign and malignant nodules. MUC-1 was present in 5/8 papillary carcinoma (62.5%), and 1/12 benign nodules (8.3%). CD26 was detected in 7/8 papillary carcinomas but also in 8/12 benign nodules. CONCLUSIONS: RT-PCR can be performed in very small samples of thyroid tissue to detect several mRNA markers. MUC-1 can be a potentially useful marker of malignancy in thyroid nodules. It can be detected by RT-PCR as a complementary technique in the diagnostic evaluation of thyroid nodules.
Assuntos
Humanos , Carcinoma Papilar/química , Biomarcadores Tumorais/análise , Nódulo da Glândula Tireoide/química , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Carcinoma Papilar/patologia , Eletroforese em Gel de Ágar , Estudos Prospectivos , Nódulo da Glândula Tireoide/patologia , RNA Mensageiro/análiseRESUMO
Galectin-3 is a protein of the lectin family that has been associated with neoplastic processes in various tissues. In the thyroid, expression of this protein has been described in differentiated follicular cancer, suggesting that the immunohistochemical study of galectin-3 may be a potential marker of malignancy in thyroid neoplasms. The confirmation of these results may represent an extremely useful tool for presurgical diagnosis and medical conduct. In this study, galectin-3 protein and mRNA expression were analyzed in the thyroid tissues from 87 patients with histomorphological diagnosis of multinodular goiter (MNG) (n = 24), follicular adenoma (n = 31), follicular carcinoma (n = 20), papillary carcinoma (n = 12), and five normal tissues. Galectin-3 protein expression was detected by immunohistochemical method in light, fluorescence, and confocal microscopy, using monoclonal antibody. Galectin-3 mRNA expression was detected by the RT-PCR method. Our results showed that the majority of carcinomas expressed galectin-3 protein (follicular, 90%; papillary, 100%). However, in contrast to the previously published data, benign lesions also expressed galectin-3 (adenoma, 45%; MNG, 17%). We further demonstrated by RT-PCR that thyroid tissues with diagnosis of adenoma and MNG-expressed galectin-3 mRNA. Although the galectin-3 immunostaining demonstrated a sensitivity of 93.8% in the identification of cancer, the accuracy in the distinction between benign and malignant tissues was 77.0%. This accuracy was even lower (68.6%) when the galectin-3 expression in follicular adenoma was compared with follicular carcinoma. Thus, the use of galectin-3 immunodetection as a molecular marker for thyroid carcinoma must be interpreted with caution, particularly in the differentiation between thyroid follicular carcinoma and follicular adenoma.
Assuntos
Antígenos de Diferenciação/análise , Antígenos de Diferenciação/genética , RNA Mensageiro/análise , Neoplasias da Glândula Tireoide/química , Adenocarcinoma Folicular/química , Adenoma/química , Biomarcadores Tumorais/análise , Carcinoma Papilar/química , Galectina 3 , Bócio/metabolismo , Humanos , Imuno-Histoquímica , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade , Glândula Tireoide/químicaRESUMO
RET/PTC oncogene expression is restricted to papillary thyroid carcinomas (PTC). At least three forms of this oncogene have been described. These are generated by the rearrangement of the 5'-terminal region of different expressed genes with the tyrosine-kinase (TK) domain of the ret proto-oncogene. Several studies showing the correlation between the expression of this oncogene, clinical outcome, and histological subtypes have been published. Thirty-five paraffin-embedded PTC samples from patients without a history of radiation exposure were studied. Immunohistochemistry (IHC) and in situ hybridization (ISH) were used to determine a possible correlation between RET activation, clinical outcome, and tumor subtype. Almost half of the studied cases presented with tumoral extension or metastases. Ret gene transcripts and protein were found in all PTC variants as well as in their corresponding metastases. In contrast, none of the follicular adenomas, goiters, or normal follicular cells from the thyroid gland showed evidence of ret activation. We observed a high frequency of ret expression in PTCs, suggesting that ret activation is a common event in nonradiation-related PTC from Mexican patients.
Assuntos
Carcinoma Papilar/enzimologia , Proteínas de Drosophila , Proteínas Proto-Oncogênicas/metabolismo , Receptores Proteína Tirosina Quinases/metabolismo , Neoplasias da Glândula Tireoide/enzimologia , Adulto , Carcinoma Medular/química , Carcinoma Papilar/química , Carcinoma Papilar/genética , Ativação Enzimática , Feminino , Expressão Gênica , Humanos , Imuno-Histoquímica , Hibridização In Situ , Masculino , México , Pessoa de Meia-Idade , Proto-Oncogene Mas , Proteínas Proto-Oncogênicas/análise , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas c-ret , Receptores Proteína Tirosina Quinases/análise , Receptores Proteína Tirosina Quinases/genética , Neoplasias da Glândula Tireoide/química , Neoplasias da Glândula Tireoide/genéticaRESUMO
BACKGROUND: Several tumor factors are associated with papillary thyroid cancer. Most studies do not compare the expressions of these factors in the primary tumors and in their associated cervical metastasis. METHODS: Paraffin sections of 20 patients with papillary carcinoma of the thyroid gland with lymph node metastasis were studied. The presence and distribution of insulin-like growth factor I (IGF-I) and proliferating cell nuclear antigen (PCNA) was analyzed, through immunohistochemical technique, in both primaries and lymph node metastasis. The results were correlated with clinical-pathologic data (sex, age, size of primary, multicentricity, thyroid capsule invasion, lymphatic and blood vessels invasion, development of distant metastasis, and associated thyroid diseases). RESULTS: The qualitative analysis showed the reaction for IGF-I was present in more than 90% of the neoplastic cells in both primaries and lymph node metastasis. No correlation with the clinical-pathological features was observed. Regarding the PCNA, the mean percentage of nuclei stained showed no statistical difference between primaries and metastasis (p = 0.598). Except for age, clinicopathologic data had no influence on the mean percentage of nuclei stained. A correlation was verified between the percentage of cells stained by PCNA in primary tumors and the patients' age (p < 0. 01). CONCLUSIONS: The expressions of these tumor factors are equally intense for both primary and metastatic tissue in papillary thyroid cancer. Despite the small size of the sample, the expressions of IGF-I and PCNA could not be associated to clinical-pathologic features, except for the age. As patients over 40 years old had higher expression of PCNA, this marker may have prognostic significance for patients with papillary thyroid cancer.
Assuntos
Carcinoma Papilar/química , Fator de Crescimento Insulin-Like I/análise , Antígeno Nuclear de Célula em Proliferação/análise , Neoplasias da Glândula Tireoide/química , Adolescente , Adulto , Idoso , Carcinoma Papilar/secundário , Criança , Feminino , Humanos , Imuno-Histoquímica , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/patologiaRESUMO
Alpha 1-antitrypsin is a plasma serine protease inhibitor originally used as a marker for tumors of histiocytic origin. Our casual finding of immunoreactive alpha 1-antitrypsin in one case of thyroid papillary carcinoma led us to investigate its presence in 10 thyroid papillary carcinomas by applying immunocytochemical and immunochemical techniques to tissue sections and Western blots of tissue homogenates prepared from neoplastic tissue and from uninvolved normal areas in the vicinity of each tumor. The immunocytochemical study was performed in both thyroid tissue and metastatic regional lymph nodes. This analysis revealed immunoreactivity for alpha 1-antitrypsin in nine of the 10 cases studied. Immunoreactivity was intense in some of the cells forming the papillar and follicular structures. These cells were intermingled with completely unstained tumoral cells. In contrast to neoplastic tissue, the normal thyroid tissue present in the vicinity of each tumor showed no staining for alpha 1-antitrypsin. The electrophoretic analysis performed on homogenates prepared from both tumoral and normal thyroid tissue revealed a drastic reduction in the band corresponding to thyroglobulin in the tumoral tissue compared with normal thyroid extracts, where it represented the major protein. Western blotting and immunoprinting with a polyclonal alpha 1-antitrypsin antibody confirmed the results obtained with immunocytochemistry about the presence of this protease inhibitor in neoplastic thyroid tissue. Immunoprinting with the anti-alpha 1-antitrypsin antibody revealed an intense immunoreactive band of 53 kDa in the extracts prepared from tumoral tissue. This band had exactly the same apparent molecular mass previously described by others for alpha 1-antitrypsin purified from plasma and was identical to the molecular mass of the purified commercial standard employed.
Assuntos
Carcinoma Papilar/química , Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/química , Neoplasias da Glândula Tireoide/patologia , alfa 1-Antitripsina/biossíntese , Adolescente , Adulto , Idoso , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Distribuição Tecidual , alfa 1-Antitripsina/químicaRESUMO
OBJECTIVE: Lactoferrin is an iron-binding protein that has been used for distinguishing normal from neoplastic conditions in many different tissues. In order to improve evaluation of thyroid lesions, we studied the lactoferrin immunoreaction in cytologic smears obtained by fine needle aspiration and in biopsy samples from primary neoplasms and from adenomatous goiter. STUDY DESIGN: A retrospective study on fine needle aspiration cytology samples and corresponding available biopsies from thyroid lesions in patients examined at São Paulo County Hospital between 1982 and 1992, performed in order to evaluate lactoferrin immunoreactivity in morphologically well characterized samples from neoplastic and nonneoplastic lesions. Immunoperoxidase procedures were performed using monospecific polyclonal rabbit antihuman lactoferrin as a primary antibody and biotinylated goat antirabbit IgG as a secondary antibody. Amplification was performed with the avidin-biotin-peroxidase complex, and the color sign of the positive reactions was developed using a diaminobenzidine solution. RESULTS: Lactoferrin was not detected in cytologic smears from goiters, whereas only one biopsy was slightly positive (1/21, or 4.76%). One smear from adenoma showed low positive staining (1/19, or 5.26%), which was present in 4 of 13 biopsies (30.77%) from adenoma. Papillary carcinomas were positive in 19 of 33 smears (57.58%) and in 100% of biopsies, whereas 31.25% (5/16) of follicular carcinoma smears were positive for lactoferrin, detected in all the biopsy samples. CONCLUSION: Lactoferrin immunoreactivity was strongly associated with neoplastic proliferation and may be used as a useful auxiliary marker to distinguish malignant from benign thyroid lesions in cytologic smears and biopsy samples.
Assuntos
Lactoferrina/análise , Neoplasias da Glândula Tireoide/química , Adenoma/química , Adenoma/patologia , Especificidade de Anticorpos , Biomarcadores , Biópsia por Agulha , Carcinoma Medular/química , Carcinoma Medular/patologia , Carcinoma Papilar/química , Carcinoma Papilar/patologia , Diferenciação Celular/fisiologia , Bócio/patologia , Humanos , Imuno-Histoquímica , Lactoferrina/imunologia , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologiaRESUMO
As concentraçöes séricas de tireoglobulina (Tg), T3, T4 e TSH foram analisadas em 52 pacientes com carcinoma diferenciado de tireóide após tireoidectomia total, enquanto a medicaçäo supressiva por L-tiroxina havia sido suspensa. Mapeamento ósseo, radiografia torácica e mapeamento radioisotópico de corpo inteiro (MRCI) foram igualmente solicitados. Os pacientes foram divididos em três grupos: G1) sem remanescente tissular tireóideo na área cervical (n=12); G2) com remanescente tissular tireóideo cervical mas sem metástases locais ou distantes (n=27); e G3) com a presença de metástases pulmonares, ósseas ou cervicais (n=13). As concentraçöes de Tg séricas foram, respectivamente (média DP): 99 + ou - 5,7 µg/L (G1), 29,9 + ou - 22,9 µg/L (G2) e 564,8 + ou - 833,4 µg/L (G3). Observou-se correlaçäo significativa entre os achados clínicos, a presença de MRCI positivo ou negativo e o nível de Tg sérica. As concentraçöes séricas de Tg revelaram-se mais sensíveis que o MRCI para detecçäo de eventual metástase, apesar de haver certo grau de superposiçäo de valores de Tg sérica entre os pacientes dos grupos 2 e 3. Em outro grupo de pacientes (n=141) com diagnóstico prévio de câncer de tireóide diferenciado, analisou-se a Tg sérica por método imunorradiométrico (IRMA), enquanto os indivíduos se achavam sob a açäo de doses supressivas de L-tiroxina. A Tg sérica mostrou-se näo detectável (<1,0 µg/L) em 94 por cento dos pacientes do grupo 1 (sem remanescente tireóideo) e em 75 por cento dos indivíduos do grupo 2. A Tg sérica variou de <1,0 µg/L até 88 µg/L nos pacientes dos grupos 3 e 4. Concluímos que o método IRMA usando dois anticorpos monoclonais é mais sensível e permite melhor acompanhamento, com mais segurança, do paciente com diagnóstico prévio de câncer de tireóide. Recomenda-se que a verificaçäo da Tg sérica seja realizada com um MRCI em pacientes tireoidectomizados, pelo menos na fase inicial.