Falvo L

Prognostic Importance of Histologic Vascular Invasion in Papillary Thyroid Carcinoma

Objective:To conduct a retrospective study of 39 patients with papillary carcinoma of the thyroid with histologic vascular invasion (VI+) and 361 patients without any sign of vascular invasion (VI−). Summary Background Data:In the present study, we undertook a retrospective analysis of papillary carcinoma of the thyroid to assess whether histologically determined vascular invasion can be considered a predictive factor for prognosis. Methods:By means of a retrospective study, we evaluated the departments database of patients with papillary thyroid carcinoma who had undergone total thyroidectomy from January 1993 to December 1999. Results:Group I consisted of papillary carcinoma without any sign of vascular invasion (VI−) comprising 361 patients. Group II consisted of papillary carcinoma with vascular invasion (VI+) comprising 39 patients. At the time of diagnosis, we observed no metastases in patients with VI−, whereas a pulmonary metastasis was observed in 1 patient with VI+ (P = 0.0023). In 3.6% patients with VI− and in 20.5% patients with VI+, we observed recurrences in the regional lymph nodes (P < 0.001); we observed 6 (1.66%) distant metastases in patients with VI− and in the 12.8% patients with VI+ (P < 0.001). Three patients with VI+ (7.7%) and 2 patients with VI− (0.6%) died of tumor-related causes; these figures were found to be statistically significant (P < 0.001). Conclusions:In papillary carcinoma, it should be noted that histologic vascular invasion may be considered as a sign of an increased tendency toward hematogenic invasion and consequent increase in the relative percentage of metastases; ultimately, this means a poorer prognosis. In the presence of risk factors indicating a possible increase in biologic aggressiveness, adequate postoperative treatment and close follow up become essential.

Sclerosing Papillary Carcinoma Arising in a Lingual Thyroid: Report of a Case

Ectopic lingual thyroid tissue is an uncommon congenital anomaly. Tumors with identical pathological characteristics to those arising in thyroid tissue may be present in ectopic locations, but there are very few cases of malignant ectopic thyroid tumors reported in the literature. We present a review of this phenomenon and report a case of papillary carcinoma of the base of the tongue, located in ectopic lingual thyroid tissue, in a 30-year-old woman. The patient’s presenting symptoms were dysphagia and oral bleeding, and we performed radical resection of the neoformation at the base of the tongue with part of the muscles of the floor of the mouth and the body of the hyoid bone, as well as total thyroidectomy. Histological examination revealed a “sclerosing” papillary carcinoma. The patient was treated with 131I and substitutive thyroid hormonal therapy. An ultrasonogram done 5 years later showed bilateral laterocervical lymph node recurrence, which was effectively treated with bilateral laterocervical lymphectomy.

Deregulated expression of aurora kinases is not a prognostic biomarker in papillary thyroid cancer patients

A number of reports indicated that Aurora-A or Aurora-B overexpression represented a negative prognostic factor in several human malignancies. In thyroid cancer tissues a deregulated expression of Aurora kinases has been also demonstrated, butno information regarding its possible prognostic role in differentiated thyroid cancer is available. Here, weevaluated Aurora-A and Aurora-B mRNA expression and its prognostic relevance in a series of 87 papillary thyroid cancers (PTC), with a median follow-up of 63 months. The analysis of Aurora-A and Aurora-B mRNA levels in PTC tissues, compared to normal matched tissues, revealed that their expression was either up- or down-regulatedin the majority of cancer tissues. In particular, Aurora-A and Aurora-B mRNA levels were altered, respectively, in 55 (63.2%) and 79 (90.8%) out of the 87 PTC analyzed.A significant positive correlation between Aurora-A and Aurora-B mRNAswas observed (p=0.001). The expression of both Aurora genes was not affected by the BRAFV600E mutation. Univariate, multivariate and Kaplan-Mayer analyses documented the lack of association between Aurora-A or Aurora-B expression and clinicopathological parameterssuch as gender, age, tumor size, histology, TNM stage, lymph node metastasis and BRAF status as well asdisease recurrences or disease-free interval. Only Aurora-B mRNA was significantly higher in T(3-4) tissues, with respect to T(1-2) PTC tissues. The data reported here demonstrate that the expression of Aurora kinases is deregulated in the majority of PTC tissues, likely contributing to PTC progression. However, differently from other human solid cancers, detection of Aurora-A or Aurora-B mRNAs is not a prognostic biomarker inPTC patients.

SIMULTANEOUS OCCURRENCE OF MEDULLARY CARCINOMA AND PAPILLARY MICROCARCINOMA OF THYROID IN A PATIENT WITH MEN 2A SYNDROME. REPORT OF A CASE

We report a case of simultaneous multifocal medullary carcinoma and papillary microcarcinoma in a patient with several distinctive features of MEN 2A. The patient underwent total thyroidectomy and central lymph node dissection. The extreme rarity and pathological features of this occurrence are discussed. There is no known common cause of these 2 different tumor types; it may be a stochastic exception. However, several other possibilities such as a common precursor cell or a common tumorigenic stimulus offer interesting perspectives for speculation.

Peripheral primitive neuroectodermal tumor (PPNET) of pelvic origin: report of a case arising from an unusual location.

We report a rare case of a peripheral primitive neuroectodermal tumor (PPNET) originating from the left ileopsoas muscle in an adult patient with neoplastic thrombosis of the left external iliac vein, the common femoral vein and the left popliteal vein. We performed a median laparotomy with an oblique left inguinal incision to remove the neoplasm, which consisted of a large mass surrounding the iliac-psoas muscles, extending from the transverse apophysis of the spinal column to Scarpas triangle, and passing through the lacuna musculorum. Histopathological examination revealed a primitive neuroectodermal tumor (PNET) with focal areas of necrosis, hemorrhage and vascular invasion. Immunophenotyping was positive for CD99, NSE, and focally for CK. Ultrastructural examination of the neoplastic cells showed often multiple nuclei with dense chromatin and very large nucleoli. The patient was discharged ten days after the operation. Adjuvant treatment consisted of radiotherapy at a dose of 2000 cGy in five fractions followed by six cycles of chemotherapy. The venous thrombosis was treated by anticoagulant therapy and recanalization of the occluded veins was obtained after two months of therapy. An MRI scan, carried out 12 months later, showed a local relapse, which was treated with chemotherapy and arterial chemoembolization.A peripheral primitive neuroectodermal tumor arising from the and prostate gland) and urinary and fecal diversion. Adjuvant abdominopelvic cavity is reported in a 24-year-old young male chemotherapy (VAIA) was delivered once the histology was without any previous remarkable pathology. He was admitted confirmed. We reviewed the available literature focusing on to our hospital with complaints of urinary symptoms (acute the varied nomenclature of this tumor (peripheral neuroepitheurinary retention) and mild intestinal occlusion that had been lioma, Askins tumor, Ewings extraosseous tumor, peripheral present for three months. Physical examination and CT scan adult neuroblastoma, peripheral primitive extracranial neurevealed a pelvic mass occupying the entire pelvic cavity. The roectodermal tumor (PPNET), the clinical features, the role of diagnostic workup included a CT-guided biopsy which defined diagnostic imaging techniques, pathologic assessment and the tumor as a sarcomatous type. Radical surgery was perforcontroversial therapeutic management. In addition, the promed including tumor resection, pelvic exenteration (bladder gnosis and survival of this rare condition were analyzed.