Ronald H. Nishiyama

Anaplastic spindle‐cell and giant‐cell tumors of the thyroid gland

Fifty‐three cases of anaplastic spindle‐cell and giant‐cell tumors of the thyroid gland were found in the files of the University of Michigan Medical Center in a 37‐year period (1932‐1969). Of these, 42 were found with other well‐differentiated thyroid carcinomas: papillary, follicular, Hürthle cell, clear cell, and medullary carcinomas. Data from this report and the recent literature support the conclusion that anaplastic tumors of the thyroid gland probably arise in preexisting well‐differentiated thyroid carcinomas. The grim prognosis for anaplastic carcinomas of the thyroid gland is reemphasized in this study; 49 of the 53 patients died within the first year after a histologic diagnosis was established.

Hodgkin's disease in children

Relatively few studies of Hodgkins disease (H.D.) in children have used the histologic criteria of the Rye classification. In our study, 55 cases of H.D. in children of 15 years and younger were histologically classified according to the Rye scheme. The cases were divided into 3 groups: 1. all patients, 2. those in their first decade of life, and 3. those aged 11 through 15. The majority of children were boys (62%). Nodular sclerosis was the most frequent histologic type seen in all children (49%) and in the third group (57%), whereas no preponderant histologic type was seen in the younger age group. Most cases of lymphocytic predominance were clinical Stage I, and the bulk of the long‐term survivors had this histologic type. Although seen in all clinical stages at the time of diagnostic biopsy, most cases of nodular sclerosis were Stage II. Prognosis of patients with nodular sclerosis was considerably worse than that of children with lymphocytic predominance. The results of our study are compared to those of other investigators.

Small cell tumors of the thyroid A clinicopathologic study

Fourteen cases of small cell tumors of the thyroid gland were seen at the University of Michigan Medical Center from 1932 to 1969. Nine were identified as reticulum cell sarcomas. Although the microscopic patterns in these were similar to those in the literature describing small cell carcinomas of the thyroid, four of seven patients who were treated with resection and radiation were apparently cured. No useful purpose was found for classifying tumors as small cell carcinomas. Two cases with lymphocytic lymphomas were also apparently cured by radiation, treatment. In three patients, the primary thyroid cancers were Burkitts lymphomas. These went unrecognized during life and were also treated with radiation therapy; no patient survived longer than 8 months. Since cyclophosphamide may be more efficacious than radiation therapy for Burkitts lymphoma, recognition of this lesion is of practical importance.

Primary mucinous adenocarcinoma of thyroid gland

A mucin‐producing carcinoma in the thyroid gland found in a 44‐year‐old man was first thought to be a metastatic carcinoma, possibly from salivary gland. However, follow‐up examinations for 8 years have not demonstrated another neoplasm, and it seems reasonable to conclude that this lesion was a rare primary mucinous adenocarcinoma of the thyroid gland.

Radiation exposure and the simultaneous occurrence of primary hyperparathyroidism and thyroid nodules.

Exposure to radiation has been implicated in the unexpectedly high occurrence of primary hyperparathyroidism and simultaneous nonmedullary thyroid carcinomas. The authors review the evidence and suggest ways of evaluating patients for both conditions, including obtaining a careful history of radiation exposure, and periodic reevaluation of those exposed.

Ectopic thyroid tissue in the neck. Benign or malignant

This is a report of ectopic thyroid tissue in the neck, associated with a nodular colloid goiter, which recurred at least three times, beginning at age 24 years, in a woman in 12 years. The ectopic tissue appeared histologically benign and was identical to that found in the thyroid gland. Scintiscans of the neck and thyroid suppression tests showed that the tissue was initially unsuppressible and presumably autonomous in its function. Our conclusion is that the most reasonable explanation for this phenomenon is the intraoperative transmission of thyroid cells, probably benign and autonomous in function, to other sites in the neck.

Sarcoidosis, Hypercalcemia and Primary Hyperparathyroidism The Vicissitudes of Diagnosis

Abstract Two cases of coexistent sarcoidosis and primary hyperparathyroidism are reported from the University of Michigan Medical Center from a series of 600 consecutive cases of primary hyperparathyroidism. The histopathologic finding of noncaseating granulomas within a parathyroid adenoma in one patient has not been previously reported. Two additional patients with suspected primary hyperparathyroidism had sarcoidosis detected by paratracheal lymph node biopsy done at the time of neck exploration.

The Benefits of Corticosteroids in Endotoxic Shock

The experiments reported here were undertaken to study the effects of pharmacological doses of corticosteroids administered alone or in conjunction with prolonged (12-hour) assisted circulation in 22 dogs subjected to LD50-60 Escherichia coli endotoxin. The most striking findings were lengthened survival time, higher cardiac output, decreased fluid requirement, and minimal evidence of pulmonary congestion or injury in the animals treated with steroids only. Unexplained mesenteric infarction prematurely terminated the experiments in animals undergoing assisted circulation. The benefits of corticosteroids in experimentally induced endotoxic shock are clearly demonstrated in these experiments. Further studies are needed to clarify the supportive role of assisted circulation in endotoxic shock and to determine any possible advantage of hypothermia over normothermia during its course.

Surgical treatment of thyrotoxicosis in children and adolescents

Forty-one children and adolescents had thyroidectomies for Grave’s disease during an 8 yr period. Twenty patients became euthyroid within a short period after treatment with antithyroid drugs and had operations with minimal ditruption of their lives. Antithyroid drugs were administered to 20 patients for a longer period of time as a primary form of treatment for Grave’s disease. Complications resulting from drug toxicity, poor cooperation by patients, and persistent goiters were indications for thyroidectomier in this group. Permanent remissions, after prolonged antithyroid drug therapy, are rare in children. Because the treatment is associated with significant morbidity, this form of therapy is unacceptable in most cases. Iodine-131 was given to 30 children or adolescents for Grave’s disease during the same time period. Iodine-131 is primarily indicated for patients who are resistant or allergic to antithyroid drugs, I7 ORTY-FIVE CHILDREN, 13 yr who have serious systemic diseases, or who have had previous thyroid opemtions. Hypothyroidism is an inevitable result of effective “‘I treatment of Grave’s disey;; in children. Serious consequences from I therapy were not observed during the short period of follow-up. Subtotal thyroidectomy continues to be the preferred primary treatment for most patients with Grave’s disease in childhood. Total thyroidectomy may be indicated for patients in the first decade of life. Hypothyroidism, which is easily managed in this age group, is the price paid for the prevention of recurrent Grave’s disease. Early detection and treatment of hypothyroidism can be achieved only by a careful follow-up of all patients treated by less than total thyroidectomy for Grave’s disease.

Lymph nodal Kaposi's sarcoma and chronic lymphocytic leukemia associated with a hepatic nodule simulating Hodgkin's disease.

This is a report of a patient who died of chronic lymphocytic leukemia in whom there was primary involvement of the cervical, mesenteric, and retroperitoneal lymph nodes by Kaposis sarcoma and nodular involvement of the liver by a lesion which was histologically indistinguishable from Hodgkins disease. The latter findings were demonstrated at necropsy. The association of Kaposis sarcoma with neoplasms of the reticuloendothelial system has been well documented, and the combination of Kaposis sarcoma and reticuloendothelial neoplasms has led to speculation that Kaposis sarcoma may arise from a cell of the reticuloendothelial system.