Glen W. Sizemore

Medullary Thyroid Carcinoma: Clinicopathologic Features and Long-Term Follow-Up of 65 Patients Treated During 1946 Through 1970

We retrospectively reviewed the medical records of 65 consecutive patients with medullary thyroid carcinoma, who had had their primary surgical treatment at the Mayo Clinic during the years 1946 through 1970. Of these patients, 58 had sporadic and 7 had familial medullary thyroid carcinoma. Thyroid nodules were the most common initial manifestation. Near-total thyroidectomy was the most frequent initial operation. Survival was affected by the following factors: male sex, familial inheritance, size of the tumor, stage of the tumor (American Joint Committee on Cancer), and completeness of initial resection of the tumor. The mean duration of follow-up was 23.5 years, and the maximal follow-up was 36 years. Among 52 patients without initial distant metastatic involvement and with complete resection of the tumor, 20-year survival free of distant metastatic lesions was 81%. Overall 10- and 20-year survival rates were 63% and 44%, respectively. Because of the substantial morbidity and mortality associated with medullary thyroid carcinoma, early diagnosis and thorough initial resection of the tumor are important.

Use of 131I-MIBG Scintigraphy in the Evaluation of Suspected Pheochromocytoma

Studies at the University of Michigan have shown that 131I-metaiodobenzylguanidine (131I-MIBG) is an effective agent for the diagnosis and localization of pheochromocytomas and paragangliomas. We conducted a study that confirmed and expanded that finding. From January 1983 to March 1984, 48 patients at our institution had 51 131I-MIBG scans during the workup of suspected sporadic or metastatic pheochromocytoma. Scintigrams were obtained after 500 microCI of 131I-MIBG had been administered intravenously. The final diagnosis (true-positive, false-negative, or false-positive result) was made at operation and pathologic examination. A true-negative diagnosis was confirmed by normal plasma and fractionated urinary levels of catecholamines and metabolites and, in most patients, computed tomography (CT). There were 20 true-positive studies (6 pheochromocytomas, 4 paragangliomas, and 10 metastatic or recurrent pheochromocytomas) and 24 true-negative studies. One patient with a suspected recurrent paraganglioma near the bladder had a false-positive 131I-MIBG scan (and also a false-positive (CT). Among six patients with false-negative scintigrams (three pheochromocytomas, one paraganglioma, and two metastatic lesions), one also had a false-negative CT. The overall sensitivity of 131I-MIBG scanning was 77%, specificity was 96%, and accuracy was 86%. This test is fairly sensitive in the workup of patients with known or suspected recurrent or metastatic pheochromocytoma. It may also be helpful in the evaluation of suspected sporadic pheochromocytoma when CT findings are normal.

Renal cell carcinoma with metastasis to the thyroid gland.

Cancers that metastasize to the thyroid gland are uncommon. Metastasis to the thyroid gland has been reported in renal cell carcinoma (RCC), breast cancer, lung cancer, gastrointestinal malignancies, malignant melanoma, sarcoma, hematologic malignancies, and other genitourinary cancers. A computer search of the records of the department of pathology at Loyola University Medical Center was done to determine the number of thyroidectomies performed between 1988 and 1998. A detailed review of the clinical records of patients with metastasis to the thyroid gland from RCC was done. A total of 941 thyroidectomies were performed between 1988 and 1998. Metastasis to the thyroid gland was seen in six cases (0.64%). Three of these six cases had metastasis from RCC. The interval between the diagnosis of the primary RCC and the thyroid metastasis was 2 to 10 years. Two of these three patients had an adenomatous thyroid gland. Metastases to the thyroid, though relatively rarely diagnosed clinically as a cause of thyroid nodule, must be considered in the differential diagnosis of thyroid nodule, particularly in patients who have a history of RCC.

Hypertensive crisis, catecholamine cardiomyopathy, and death associated with pseudoephedrine use in a patient with pheochromocytoma.

OBJECTIVE To describe a woman with a previously unrecognized pheochromocytoma who died after ingesting over-the-counter pseudoephedrine-containing medications. METHODS We present a case report including laboratory, radiographic, and pathologic findings in a patient with a previously unrecognized pheochromocytoma. RESULTS A 31-year-old woman had symptoms consistent with intermittent, excessive release of catecholamines since childhood. She developed an upper-respiratory infection and used over-the-counter medications containing pseudoephedrine. Subsequently, she developed a hypertensive crisis with congestive heart failure and died of a cardiac arrhythmia and shock. Findings from postmortem examination included a right adrenal pheochromocytoma, congestive heart failure, and catecholamine cardiomyopathy. CONCLUSION This patient death may be linked to the use of pseudoephedrine hydrochloride. Physicians and pharmacists should warn patients with known pheochromocytoma or those at risk for having pheochromocytoma on the basis of family history or genetic testing that pseudoephedrine use may be harmful. Over-the-counter packaging should include such warning.