Angiotropic lymphoma occurring in a lacrimal sac oncocytoma.
(17/183)This report describes a case of angiotropic variant of diffuse large B cell lymphoma within a benign oncocytoma of the lacrimal sac. The occurrence of this rare lymphoma within a benign neoplasm has not been documented previously. An 87 year old woman presented with a swelling over the area of the left lacrimal sac, which histological examination revealed to be an oncocytoma. Many small blood vessels within the tumour were filled with large cytologically atypical cells, which stained positively for leucocyte common antigen and a B cell antigen, CD20, confirming the presence of a large B cell non-Hodgkin's lymphoma of angiotropic type. Angiotropic lymphoma is a very rare and usually highly aggressive variant of non-Hodgkin's lymphoma, which classically involves the central nervous system and skin, but has been described within most organs. Its occurrence within a benign neoplasm is probably coincidental, although a close association between oncocytic epithelium and normal lymphoid cells is recognised in Warthin's tumour of salivary and lacrimal glands. (+info)
Evidence-based criteria for adequacy in thyroid fine-needle aspiration.
(18/183)To determine whether some thyroid fine-needle aspirates classified as nondiagnostic correlate with benign thyroid nodules and can be distinguished from other nondiagnostic aspirates, I reviewed (from a total of 1,581) 80 nondiagnostic cases, all of which were hypocellular and lacked colloid, and correlated the cytologic findings with the results of pathologic follow-up. Of the 80, 16 had carcinoma at follow-up and 64 were benign. The cellularity of the carcinoma cases ranged from 0 to 100 cells (mean, 20 cells), but every case with epithelial cells had Hurthle cell change or atypia suggestive of papillary carcinoma. The cellularity of the 64 benign cases ranged from 0 to 120 cells (mean, 40 cells), 17 of which had Hurthle cell change. There were 25 cases with at least 10 benign-appearing follicular cells without atypia or Hurthle cell change; all 25 cases were associated with benign follow-up. While these results need to be confirmed by others, the evidence suggests that a proportion of thyroid aspirates that do not meet traditional criteria for adequacy still may be associated strongly with a benign thyroid nodule and can be distinguished from other nondiagnostic aspirates. (+info)
Hurthle cell carcinoma is a better gold standard than Hurthle cell neoplasm for fine-needle aspiration of the thyroid: defining more consistent and specific cytologic criteria.
(19/183)BACKGROUND: The majority of fine-needle aspirates of the thyroid that demonstrate a predominance of Hurthle cells are diagnosed as suspicious for Hurthle cell neoplasm. Only a minority of these patients are found to have carcinoma at the time of resection. In the current study, an attempt was made to define criteria that were more specific for Hurthle cell carcinoma without a loss in sensitivity. METHODS: The literature was reviewed and 33 aspiration samples diagnosed as suspicious for a Hurthle cell neoplasm (4 nonneoplastic cases, 19 adenoma cases, and 10 carcinomas) were reexamined and reclassified based on criteria derived from the literature. RESULTS: All Hurthle cell carcinomas could be identified using a total of five criteria: predominantly Hurthle cells and scant colloid and at least one of either small cell dysplasia (cytoplasmic diameter less than twice the nuclear diameter, with often quite bland cells), large cell dysplasia (greater than twice the variation in nuclear diameter; large cells typically demonstrate prominent nucleoli and irregular nuclear outlines), crowding (nuclei touching), and dyshesion (single cells). Three of 4 nonneoplastic aspiration samples (75%) and 7 of 19 Hurthle cell adenomas (37%) did not meet these criteria and could reliably be diagnosed as benign. CONCLUSIONS: By focusing on criteria for Hurthle cell carcinoma rather than all Hurthle cell neoplasms, criteria can be developed that improve the specificity without a loss of sensitivity. (+info)
E2F-1 transcription factor is overexpressed in oxyphilic thyroid tumors.
(20/183)In thyroid tumors, several cell cycle regulators have been found to be altered or overexpressed, but no data exist on E2F transcription factors. Such factors (E2F-1 in particular) act as the final effectors in the retinoblastoma pathway but are also involved in apoptosis. To analyze E2F-1 expression in thyroid neoplasms, we investigated 73 thyroid tumors, including 28 oxyphilic and 45 nonoxyphilic lesions, by immunohistochemistry, in parallel with other cell cycle-related proteins (p27, pRb, p53, and Ki67). p27, Ki-67, pRb, and p53 expression patterns generally overlapped the literature data. E2F-1 was expressed in all thyroid tumor types, both benign and malignant, with no statistical correlation with proliferative status (except for anaplastic carcinoma). A significantly higher percentage of tumor cells expressed E2F-1 in oxyphilic adenomas (71.5%) and oxyphilic carcinomas (66.1%) as compared with that of the corresponding nonoxyphilic lesions (30.8% and 34.5%, respectively; P < .05). These same tumors had a relatively low proliferative index. Therefore, because oxyphilic tumors of the thyroid show peculiar morphological, phenotypic, and ultrastructural features, possibly related to their particular metabolic conditions, it is possible that E2F-1 overexpression is linked to activities other than cell cycle entry in oxyphilic tumors. In conclusion, E2F-1 is expressed in both benign and malignant thyroid tumors, thus suggesting a wide involvement of the retinoblastoma pathway in thyroid tumorigenesis. In addition, in oxyphilic tumors, more than two thirds of tumor cells express E2F-1, an event possibly linked to proapoptotic rather than proliferative signals in such neoplasms. (+info)
Genetic interactions between the Wilms' tumor 1 gene and the p53 gene.
(21/183)In recent years, a number of proteins have been identified that can modify the activities of the Wilms' Tumor 1 (WT1) proteins. One of these modifiers is the p53 protein. To investigate a genetic interaction between the p53 gene and the wt1 gene, we have crossed their respective knockout mice. The absence of p53 appears to have no gross effect on the phenotype of wt1-null mice. Both wt1-null and double-null embryos develop pericardial bleeding and die in utero. In adult p53-null mice, wt1-heterozygosity (wt1het) predisposes to an earlier onset of lymphomagenesis and the development of kidney abnormalities resembling oncocytoma in humans. wt1-heterozygosity alone predisposes to the development of glomerular sclerosis. (+info)
Prognostic factors in patients with Hurthle cell neoplasms of the thyroid.
(22/183)BACKGROUND: Hurthle cell neoplasms, often considered a variant of follicular thyroid neoplasms, represent 3% of thyroid carcinomas. Only a handful of publications have focused on the biologic behavior, prognostic factors, and treatment outcomes of Hurthle cell carcinoma. The objective of the current study was to identify the clinical and pathologic features of Hurthle cell carcinomas that predict disease progression or death. METHODS: The authors reviewed medical records of patients who were treated for Hurthle cell carcinoma (HCC) and Hurthle cell adenoma (HCA) at The University of Texas M. D. Anderson Cancer Center from March 1944 to February 1995, including follow-up information. The pathologic diagnosis was confirmed by one of the authors. RESULTS: The authors identified 127 patients with Hurthle cell neoplasms, 89 patients with HCC and 38 patients with HCA. Seven patients with HCC had foci of anaplastic thyroid carcinoma. Survival for this subgroup was worse compared with the overall group and was analyzed separately. The HCC group was significantly older (age 51.8 years vs. age 43.1. years) and had larger tumors (4.3 cm vs. 2.9 cm) compared with the HCA group. No differences were seen in gender or previous radiation exposure. Forty percent of patients in the HCC group died of thyroid carcinoma, whereas no patients in the HCA group died of the disease. There has been no improvement in all-cause and disease specific mortality in the past 5 decades for patients with these neoplasms. Conventional staging systems predicted mortality with minor differences. Of the patients with known metastasis, 38% showed radioiodine uptake. Univariate analysis identified older age, higher disease stage, tumor size, extraglandular invasion, multifocality, lymph node disease, distant metastasis, extensive surgery, external beam radiation therapy, and chemotherapy as factors that were associated with decreased survival. Tumor encapsulation was associated with improved survival. Although radioactive iodine treatment had no overall effect on survival, subgroup analysis showed that patients who received radioactive iodine for adjuvant ablation therapy had better outcomes compared either with patients who did not receive radioactive iodine or with patients who received radioactive iodine as treatment for residual disease. Multivariate analysis indicated that older age and larger tumor size predicted worse survival through an association with worse behaving tumors (multifocal, less encapsulated, and with extraglandular invasion). The decreased survival in patients with lymph node metastases may be explained by its association with distant metastases. The association of extensive surgery, external beam radiation therapy, and chemotherapy with worse survival also disappeared once those factors were analyzed together with other prognostic factors, such as distant metastases. CONCLUSIONS: Several clinical and pathologic prognostic factors were identified in patients with HCC and HCA. Older age and larger tumor size predicted reduced survival. Radioactive iodine therapy may confer a survival benefit when it is used for adjuvant ablation therapy, but not when residual disease is present. The authors could not demonstrate a survival benefit for the use of extensive surgery, external beam radiation therapy, or chemotherapy. (+info)
Reversible migratory osteoporosis in renal oncocytoma mimicking renal cell carcinoma with bone metastases.
(23/183)We report a case in which initially the wrong diagnosis of renal cell carcinoma with bone metastases was made. Nephrectomy and bone biopsy led to the right diagnosis of oncocytoma with transient osteoporosis. This report stresses the importance of pathological investigation and points to oncocytoma in the differential diagnosis of solid renal masses. In addition, the possible relationship between this tumour and migratory osteoporosis, which disappeared after surgery, is described. (+info)
Outcome in patients with differentiated thyroid cancer with negative diagnostic whole-body scanning and detectable stimulated thyroglobulin.
(24/183)BACKGROUND: Management of patients with differentiated thyroid carcinoma with negative diagnostic radioiodide scanning and increased serum thyroglobulin (Tg) concentrations is a widely debated problem. High-dose iodine-131 treatment of patients who have a negative (131)I diagnostic whole-body scan (WBS) is advocated. However, the therapeutic benefit of this "blind" treatment is not clear. OBJECTIVE: To investigate the course of serum Tg during thyroid hormone suppression therapy (Tg-on) and clinical outcome in patients with negative diagnostic (131)I scanning and increased serum Tg concentrations during thyroid hormone withdrawal (Tg-off), after treatment with high-dose (131)I. DESIGN: Retrospective single-center study. METHODS: Fifty-six patients were treated with a blind therapeutic dose of 150 mCi (131)I. Median follow-up from this treatment until the end of observation was 4.2 Years (range 0.5-13.5 Years). RESULTS: The post-treatment WBS revealed (131)I uptake in 28 patients, but none in the remaining 28 patients. In this study the Tg-on values did not change after treatment in either the positive or the negative post-treatment WBS group. During follow-up, 18 of the 28 patients with a positive post-treatment WBS achieved complete remission, compared with 10 of the 28 patients with a negative post-treatment WBS. Nine patients in the negative group died, but no patients died in the positive post-treatment group (P=0.001). CONCLUSIONS: High-dose iodine treatment in diagnostically negative patients who have a negative post-treatment scan seems to confer no additional value for tumor reduction and survival. In patients with a positive post-treatment scan, high-dose iodine treatment can be used as a diagnostic tool to identify tumor location, and a therapeutic effect may be present in individual cases. (+info)