Mary E. Cunnane

The TRK-T1 fusion protein induces neoplastic transformation of thyroid epithelium.

Genetic analysis of human papillary thyroid carcinomas (PTC) has revealed unique chromosomal translocations that form oncogenic fusion proteins and promote thyroid tumorigenesis in up to 60% of tumors examined. Although, the majority of thyroid specific translocations involve the growth factor receptor c-RET, variant rearrangements of the receptor for nerve growth factor, NTRK1 have also been described. One such translocation, TRK-T1, forms a fusion protein composed of the carboxyl terminal tyrosine kinase domain of NTRK1 and the amino terminal portion of TPR (Translocated Promoter Region). To determine if TRK-T1 expression can cause thyroid cancer in vivo, we developed transgenic mice that express the human TRK-T1 fusion protein in the thyroid. Immunohistochemical analysis of TRK-T1 transgenic mouse thyroids revealed TRK-T1 staining within the thyroid follicular epithelium. In contrast to nontransgenic littermates, 54% of transgenic mice developed thyroid abnormalities that included follicular hyperplasia and papillary carcinoma. Furthermore, all transgenic mice examined greater than 7 months of age developed thyroid hyperplasia and/or carcinoma. These data support the conclusion that TRK-T1 is oncogenic in vivo and contributes to the neoplastic transformation of the thyroid.

Cyclooxygenase-2 expression in human thyroid carcinoma and Hashimoto's thyroiditis.

Objectives Cyclooxygenases (COX) are enzymes that catalyze the conversion of arachidonic acid to prostaglandins. COX‐2, unlike the constitutively expressed COX‐1, is an inducible enzyme upregulated during cell proliferation and inflammation. More recently, COX‐2 has been implicated in the development of numerous types of epithelial cancers. In addition, COX‐2 is highly expressed in several inflammatory diseases. Because of its dual role in inflammation and cancer, we were interested in determining if COX‐2 plays a role in the development of human thyroid carcinoma and Hashimotos thyroiditis, an autoimmune condition frequently associated with thyroid malignancy.

Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients

To study the diagnostic accuracy of physical examination (PE), ultrasonography (US), contrastenhanced computed tomography (CT) and in preoperative detection of macroscopic nodal metastasis in primary/recurrent papillary thyroid carcinoma (PTC) patients to determine if the routine addition of CT would be beneficial in accurate preoperative lymph‐node surgery planning.

Cross-Sectional Imaging of the Thyroid Gland

Directed imaging is useful in assessing the thyroid gland. Nuclear scintigraphy reveals functional information about the thyroid gland, while cross-sectional imaging, including ultrasound, CT, and MR imaging provide important adjunctive anatomic information about the thyroid as well as about related structures in the neck, including the presence or absence of cervical and mediastinal lymphadenopathy, or extension of thyroid disease into adjacent soft tissues or the mediastinum. This article reviews the anatomy and physiology of the thyroid gland and addresses issues related to diseases affecting the thyroid gland, with an emphasis on neoplasms and the role of cross-sectional MR and CT imaging in the assessment of thyroid neoplasia.

Chest tube insertion as a potential source of false-positive FDG-positron emission tomographic results.

Positron emission tomography with fluorodeoxyglucose (FDG PET) is an effective imaging technique for detecting and staging neoplastic and infectious disorders. However, FDG is a nonspecific tracer, and assessment of the nature of known abnormalities can be confounded by its accumulation in a variety of inflammatory lesions. Chest tube insertion is a common procedure in patients with a multitude of pleuropulmonary disorders, but a history of such a procedure is not always known to nuclear medicine physicians who interpret FDG-PET studies. Inflammation caused by previous chest tube insertion is a challenge and should be recognized to avoid false-positive results in such settings. This report documents a case that would have been confused with a cancerous condition in the absence of correlation with anatomic images and a detailed clinical history.

Anatomical Changes of the Ethmoid Cavity After Endoscopic Sinus Surgery

Objective: Alteration of the bony architecture of the sinus cavities has been observed in chronic sinusitis. Plasticity of the ethmoid sinus framework after endoscopic surgery, however, is a newly described entity. The objective of this study was to determine the incidence and extent of changes in ethmoid size after ethmoidectomy.

Correlation Between Aspirin Intake and Reduced Growth of Human Vestibular Schwannoma: Volumetric Analysis.

Objective: To determine whether people with sporadic vestibular schwannoma (VS) who take aspirin for unrelated medical reasons exhibit less tumor growth than nonaspirin users. We previously demonstrated the efficacy of salicylates in inhibiting VS growth in vitro, corroborating the results of our retrospective clinical study, which found halted VS growth (based on linear tumor measurements) in aspirin users. The current study evaluates this association using more accurate tumor volumetric measurements, and quantifies the degree of frequency-specific, VS-induced hearing loss. Study Design: Retrospective analysis. Setting: Tertiary care hospital. Patients: Diagnosed with VS between 1980 and 2012, followed by serial magnetic resonance imaging for at least 1 year. Main Outcome Measures: Patient history of aspirin intake; change in VS volume over time of observation; frequency-specific, VS-induced audiometric threshold shifts. Results: Of the 347 patients followed by serial magnetic resonance imaging scans, 86 had sequential scans available for 3D-segmented volumetric analysis for up to 11 years of follow-up (median 53 mo). Twenty-five (29%) had documented history of aspirin intake; 8 (32%) of these demonstrated VS growth. Of the 61 (71%) nonusers, 36 (59%) demonstrated growth. A significant inverse association was found among aspirin users and VS growth: odds ratio 0.32, 95% confidence interval 0.11 to 0.91. VS-induced audiometric thresholds shifts were larger above than below 2000 Hz. Conclusion: Our volumetric analysis of VS growth reaffirms the results of our linear analysis and suggests that aspirin may inhibit VS growth. The audiometric findings are consistent with the previously reported VS-induced predominantly high-frequency sensorineural hearing loss.

Medialization of the lamina papyracea after endoscopic ethmoidectomy: comparison of preprocedure and postprocedure computed tomographic scans.

Objective: The purpose of this article is to report computed tomography demonstration of medial bowing of the lamina papyracea in 5 patients after internal ethmoidectomy. Methods: We identified 5 patients who had apparent medial bowing of the lamina papyracea after functional endoscopic sinus surgery (FESS) and who had preoperative scans available. Preoperative and postoperative scans were reviewed using a 3-dimensional workstation to ensure similar angulation of the slices before measurement. Measurements of the interorbital distance and also the position of the posterior margin of the globe relative to a line connecting the lateral orbital walls were performed. Results: Each of the patients demonstrated a decrease in the interorbital distance on the postoperative scan. Measurement of globe position showed that 9 of the 10 globes lay in a more posterior position within the orbit on postoperative examination. Conclusions: Medial bowing of the lamina papyracea may occur as a result of FESS and may lead to relative enophthalmos in comparison. The incidence of this phenomenon is unknown because most patients are not reimaged after FESS.

Lacrimal Gland Masses

W371 tory processes tend to have a diffuse pattern, typically involving both the orbital and palpebral lobes of the gland. The palpebral lobe is the portion of the lacrimal gland that is usually visible when the upper eyelid is everted on physical examination. The lacrimal gland normally measures approximately 20 × 12 × 5 mm. Although the size of a normal lacrimal gland may vary from person to person, the glands are usually symmetric, and asymmetry is an important indicator of abnormality. On CT, the lacrimal gland is isodense to the muscle. The medial border is outlined by orbital fat and the lateral border by orbital bone (Fig. 1C). Calcifications and bony changes are well seen on CT (Fig. 2), and normal glands show symmetric contrast enhancement. The superior resolution of MRI permits better assessment of the extent of glandular and periglandular involvement. Normal lacrimal glands have intermediate (sometimes heterogeneous) signal on both T1-weighted and T2weighted imaging and enhance symmetrically after gadolinium administration (Fig. 2).

Case 5-2013

A 52-year-old woman was seen in the thyroid clinic at this hospital because of a mass in the neck. The patient had been well until 2.5 months before presentation, when she noted a mass in the right side of her neck and felt a lump in her throat when swallowing. She was seen by her primary care physician. She had a history of myxomatous mitral valve with regurgitation, cardiac arrhythmias (atrial premature complexes and ventricular premature contractions), ovarian cysts, and anxiety; she had had a total hysterectomy and right salpingo-oophorectomy for uterine fibroids. She drank alcohol in moderation and did not smoke or use illicit drugs. Medications included atenolol, lisinopril, fluoxetine, calcium carbonate, a multivitamin, and amoxicillin before dental work. She had no known allergies. She was married, had no children, and worked in an office. Her father had hypothyroidism, an aunt had a goiter, and a sister had an unspecified thyroid problem; her other siblings were healthy. On examination, the blood pressure was 128/74 mm Hg, the pulse 66 beats per minute, the weight 66.7 kg, and the height 165.1 cm. A nodule was palpable in the thyroid on the right side; there was no palpable lymphadenopathy. A grade 2/6 systolic murmur was heard at the apex. The remainder of the examination was normal. The blood level of thyrotropin was 1.74 μU per milliliter (reference range, 0.40 to 5.00). Ultrasonography of the thyroid gland revealed a heterogeneous, hypoechoic nodule (42 mm by 32 mm by 26 mm) in the midpole of the right lobe. The nodule had lobulated margins, scattered central calcification, and mild central blood flow. A solid, hypoechoic nodule (24 mm by 19 mm by 34 mm), posterior and inferior to the first nodule, contained several foci of punctate calcifications. An enlarged lymph node in the lower cervical region (level 4) on the right side of the neck had abnormal internal architecture and contained microcalcifications. The patient was referred to the thyroid clinic at this hospital. She reported a mild cough productive of yellow phlegm, occasional palpitations, and a timbre of her voice that was lower than usual, which she attributed to a recent upper respiratory infection. She had no history of radiation to the head or neck. Vital signs were