Lukács G

Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localization in primary hyperparathyroidism

Abstract. A prospective study was performed to evaluate the efficacy of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scanning and US for imaging parathyroid glands in primary hyperparathyroidism. Sixty-three patients were surgically treated for primary hyperparathyroidism (HPT). Preoperative scintigraphy and US were performed in all cases. Bilateral neck exploration was carried out on each patient. Results of radionuclide studies and US were compared with surgical and histological findings. In 57 patients with primary HPT the radionuclide scanning gave true-positive results. Four false-negative and two false-positive scintigrams were obtained. The sensitivity and the positive predictive value (PPV) of scintigraphy were 93 and 97%, respectively. Forty-one cases were correctly localized by the US. Seventeen US results were false negative and five were false positive. The sensitivity and the PPV for US were 71 and 89%, respectively. There was a statistically significant difference between the sensitivity of the scintigraphy compared with the US (p=0.001). Sensitivities of radionuclide scans and US were higher for adenomas (100 and 83%) than for hyperplastic glands (75 and 40%). The sensitivity of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scintigraphy was significantly higher compared with US. This sensitive method could help surgeons in performing a rapid and directed parathyroidectomy.

Cytofluorimetric measurements on the DNA contents of tumors cells in human thyroid gland

SummaryThe relative DNA contents of thyroid cell nuclei were measured in surgically removed thyroid tissue of 50 patients by means of cytofluorimetry. Smears were prepared immediately after removal of the thyroid nodules according to the classical Feulgen technique. The fluorescence intensities were always compared with those of healthy thyroid tissue prepared in the same way. In each case samples were investigated by the usual histology. The observations indicate that differentiated carcinomas of thyroid gland, have an increased DNA content of nuclei, at about the tetraploid level. Among them the follicular carcinomas (11 cases) showed an even higher DNA content of about 250% of the diploid level. Frequency distribution of the cell pools studied revealed a widely scattered aneuploidization of the malignant tumor cells. The benign adenomas displayed only a moderate increase of nuclear DNA content reaching only about 130% of the diploid value. Among the 22 adenomas classified histologically as of benign character, two cases showed very highly increased and widely scattered DNA contents. These latter two cases might be in process of malignant transformation. DNA cytofluorimetry may contribute to a more safe differential diagnosis of the “follicular neoplasia” of the thyroid gland.

Microfluorimetric and X-ray microanalytic studies on the DNA content and Na+:K+ ratios of the cell nucleic in various types of thyroid tumors

SummaryParallel studies were performed using microfluorimetric DNA determination and X-ray microanalysis on the same thyroid biopsy material to compare the intranuclear DNA and monovalent electrolyte contents (Na+, K+, Cl−). Samples were taken from apparently healthy, adenomatous, and cancerous parts of human thyroid glands removed surgically. The time interval was less than 1 min. The tissues were classified by the pathologist into four main classes: 1) Normal thyroid tissue; 2) benign adenomas; 3) differentiated (follicular and papillary) carcinomas; and 4) anaplastic cancers. The results revealed that the level of aneuploidization showed an increase parallel with the malignancy of the studied tumor. At the same time, a similar tendency was found in the average values of the intranuclear Na+:K+ ratios. The results obtained in this way confirm the possibility that the electric properties of the cell membrane, that is the sustained membrane depolarization, may have a role in the regulation of DNA synthesis and in mitogenesis. These results may offer new diagnostic and/or therapeutic possibilities.

Flow cytometric DNA analysis of benign hyperfunctioning parathyroid glands: significant difference in the S phase fraction and proliferative index between adenomas and hyperplasias

Aims: Flow cytometric DNA analysis was performed to measure the DNA content of benign parathyroid tumours in patients with primary hyperparathyroidism. Methods: DNA analysis of paraffin‐embedded parathyroid samples was performed on 51 parathyroid glands from 29 patients after parathyroidectomy. Histopathology showed parathyroid adenoma in 25 cases and hyperplasia in four patients. DNA ploidy status, DNA index (DI), percentage of cells in S phase and proliferative index (PI) were determined. Results: Normal cells from normal glands were all diploid. DNA cytometry showed 12 aneuploid and 13 diploid adenomas. There were 12 diploid and four aneuploid hyperplastic glands. Incidence of aneuploid DNA histograms did not show a statistically significant difference between adenomas and hyperplasias ( P = 0.216). Mean S phase fraction was 3.45% in adenomas and 1.53% in hyperplasias ( P = 0.015). Mean PI was 6.48% in adenomas and 2.78% in hyperplastic parathyroid glands. This difference was statistically significant ( P = 0.006). Diploid cases had a mean PI of 4.78% and aneuploid glands a mean PI of 7.7% ( P = 0.08). Aneuploid DNA content did not reveal statistically significant correlation with age, gender, pre‐operative Ca, alkaline phosphatase, i‐PTH levels, and tumour size. The mean S phase fraction and PI were 2.25% and 4.78% in diploid glands, and 4.5% and 7.7% in aneuploid cases. Conclusion: Aneuploid DNA content may be present in benign parathyroid diseases, but not in normal parathyroid glands. Aneuploid DNA histograms and higher PI occur more often in adenomas compared with hyperplasias, but the nuclear DNA analysis is unable to make a distinction between adenomas and hyperplasias.

Special features of childhood and juvenile thyroid carcinomas

A retrospective analysis was conducted on 36 patients who underwent surgery for childhood or juvenile thyroid cancers and who were regularly followed up during the course of 30 years. The biological properties and late prognosis of these patients were assessed, and the clinical and morphological characteristics of the tumors were examined. The distribution of the DNA content in the tumor cells was compared with that in adult tumor cells, and the results of cytogenetic tests performed on mothers operated on for thyroid tumors and their children are also discussed.

Coexistence of thyroid carcinoma and secondary hyperparathyroidism

SummaryBackgroundReports on the coexistence of secondary hyperparathyroidism (sHPT) and thyroid carcinoma are very rare.MethodsA case of secondary hyperparathyroidism and concomitant papillary thyroid carcinoma (follicular variant) is described, and compared to data from the literature.Results1 out of 26 patients undergoing parathyroidectomy for secondary hyperparathyroidism had papillary thyroid microcarcinoma (follicular variant) associated with regional lymph node metastases. Head and neck were not irradiated during the patient’s case history. Dialysis had been performed for 23 years prior to simultaneous near-total thyroidectomy, total parathyroidectomy and autotransplantation. The prolonged high parathyroid hormone levels, or massive hemosiderin deposits may have caused the development of carcinoma. The incidence rate of occult thyroid microcarcinoma in all autopsies of our geographical region and period was 4.5 per cent.ConclusionsCareful exploration of the thyroid gland, and liberal indication for biopsy of suspicious thyroid areas is mandatory in each sHPT patient who is operated on, in order to exclude possible thyroid carcinomas.ZusammenfassungGrundlagenIn der Literatur gibt es nur wenige Berichte über das gemeinsame Vorkommen von sekundärem Hyperparathyreoidismus (sHPT) und Schilddrüsenkarzinom.MethodikEin Fall von sekundärem Hyperparathyreoidismus mit gleichzeitigem papillärem Schilddrüsenkarzinom (follikuläre Variante) wird beschrieben und mit Literaturdaten verglichen.ErgebnisseUnter 26 Patienten, die wegen sHPT operiert wurden, fand sich eine Patientin mit papillärem Mikrokarzinom (follikuläre Variante) und Lymphknotenmetastasen. Anamnestisch wurde keine Bestrahlung der Kopf-Halsregion durchgeführt. Die erhöhten Parathormonwerte und die massiven Hämosiderinablagerungen während der 23 Jahre langen Hämodialyse könnten die Ursache für die Karzinomentstehung sein. Neben einer totalen Parathyroidektomie mit simultaner Autotransplantation wurde eine „near-total” Thyroidektomie durchgeführt. In derselben geographischen Region wurden im gleichen Zeitraum bei 4,5% aller Autopsien Mikrokarzinome der Schilddrüse beobachtet.SchlußfolgerungenBei jeder Halsexploration wegen sHPT ist immer die Schilddrüse sorgfältig nach einem Schilddrüsenkarzinom zu untersuchen und suspekte Schilddrüsenareale sind gegebenenfalls zu biopsieren.

Late Prognosis of Childhood and Juvenile Thyroid Carcinomas

The authors report on the biological properties and late prognosis of 16 children and juvenile patients operated on during the past 24 years for thyroid tumour who underwent regular followup. The clinical and morphological characteristics of the carcinomas are described, together with the late immune response of the patients undergoing complex treatment. The study is also concerned with the characteristics of the DNA content of the tumorous cell nuclei, the pregnancy success rate of the operated patients and the thyroid function of the children born.

535 Childhood- and juvenile thyroid carcinomas

The authors report on the late prognosis and biological properties of thyroid carcinomas in 36 patients, developed before the age of 20. All patients underwent surgical treatment and were followed up from 1962 to 1994. Papillary carcinoma was diagnosed in 30, follicular carcinoma in 4, and medullary carcinoma in 2 patients. In 11 cases cervical lymphnode excision or cytologic examination was performed before the operation, that verified the diagnosis. 24 of the 36 patients had T-2 tumors at the time of the operation. Lymph node metastasis was found in 21, lung metastasis was found in only one patient. Total thyroidectomy was performed in 18, subtotal thyroidectomy in 9 and lobectomy with isthmus resection in 9 patients. Thyroiditis accompanying the carcinonoma was diagnosed in 3 patients. Regional lymph node recurrence occurred in 8 cases. One patient was lost only, due to local recurrence. All of the patients were given thyroid hormone replacement. 20 patients became pregnant after the treatment, and 25 infants were born.

Einfluß des cellulären DBS-Gehalts auf die Überlebenschance bei differenzierten Schilddrüsencarcinomen

Vor nahezu 10 Jahren haben wir die cellulare DNS-Analyse bei ausgewahlten Schilddrusenerkrankungen angelegt, hauptsachlich zur Unterscheidung von gut- oder bosartigen tumorosen Veranderungen. Anhand unserer Messungen konnten wir zum Schlus kommen, das zwar jeder von den malignen Tumoren eine aneuploide DNS-Verteilung zeigte, ergaben sich jedoch bei den Tumoren mit grostenteils differenzierter Struktur haufig auch voneinander wesentlich abweichende Histogramme, von einer annahernd diploiden Verteilung bis zu den langgestreckten, flachen Histogrammen (1, 2). Bei der Analyse der Nachkontrollangaben unserer Patienten stellten wir die Frage, ob und auf welche Weise der DNS-Gehalt der Tumorzellen Einflus nimmt auf Verlauf und Prognose der Krankheit und was dies bedeutet fur das biologische Verhalten. Diesbezugliche Forschungen wurden bereits, wenn auch mit unterschiedlichen Methoden, von mehreren Autoren ausgefuhrt (3, 4, 5).