Tanekazu Harada

Fatal thyroid carcinoma: Anaplastic transformation of adenocarcinoma

Prognosis of well‐differentiated carcinoma of the thyroid gland is generally favorable, while that of anaplastic carcinoma, extremely poor. Well‐differentiated carcinoma may sometimes be fatal; the most common underlying cause is considered to be due to anaplastic transformation of the original well‐differentiated carcinoma to a less differentiated form. We studied 27 consecutive autopsy cases of fatal thyroid cancer treated at the Ito Hospital, Tokyo, during a five‐year period, 1969–1973. We found uniform histological features of anaplastic carcinoma in 10 cases and of well differentiated carcinoma in four cases. In addition, co‐existence of well‐differentiated and anaplastic carcinomas was observed in nine cases and well‐differentiated and squamous cell carcinomas in four. Circumstantial evidence strongly suggests that malignant transformation is a part of the natural history of thyroid carcinoma, from well‐differentiated carcinoma to less differentiated forms, either squamous cell or anaplastic carcinoma.

Aplasia of one thyroid lobe

Abstract The clinical presentation of congenital absence of one thyroid lobe is rare. We are reporting seven cases of this anomaly which were observed at the Ito Hospital from 1959 through 1971. All cases occurred in women, and five cases were aplasia of the left lobe whereas two were aplasia of the right lobe. Among the thyroid disorders which were associated with hemiagenesis, five were hyperthyroidism, one was papillary adenocarcinoma, and one was adenomatous goiter.

Experimental study on tumor affinity of 201Tl-chloride

AbstractThe tumor affinity of 201Tl was studied with normal and VX-2 cancer-bearing rabbits. 201Tl distribution in normal rabbit tissues was greatest in the kidney and heart muscle, followed by thyroid gland small intestine, spleen, lung, liver, bone marrow, bone, skeletal muscle, and blood, respectively. Accumulation into the thyroid varied greatly according to individuals. Generally, the taller the height of follicular cells, the greater was the affinity.Accumulation of 201Tl into the tumor transplanted into femoral muscle reached its maximum within 1 h after administration, and thereafter decreased gradually.When the tumor affinity was compared with that of 67Ga, the ratio of 67Ga accumulation to tissues (except blood) was greater than that of 201Tl.Accumulation of 201Tl is significantly correlated to that of 42K, and the mechanism of 201Tl-tumor affinity seems to be triggered by the acceleration of the potassium metabolism of a tumor. Accumulation into the inflammatory focus was greater with 67Ga as a ratio to muscle, while the ratio to blood was greater with 201Tl.

Bleomycin treatment for cancer of the thyroid

Abstract BLM was evaluated in clinical application to twenty-one cases of cancer of the thyroid. BLM is not as effective against thyroid cancer as it is against squamous cell carcinoma but it is considerably more effective than other anticancer drugs in cancer of the thyroid.

Clinical evaluation of 201Thallium chloride scan for thyroid nodule

Thyroid scintigraphy with Tl in the evaluation of nodules was investigated. A Tl scan was performed on 55 patients with thyroid nodules previously scanned with Tc or I. In the case of 16 carcinomas, accumulation of Tl was shown in every case. In addition, some lymph node metastases were depicted. (Accumulation was noted also in some of the metastatic lymph nodes.) Cold defect was delineated in ten cases of colloid and fetal adenoma, although accumulation was shown in four cases of Hürthle and embryonal adenoma. Six cases of degenerative cysts were delineated as cold defect. As for colloid nodular goiter, the affinity to the individual nodule was not constant. In general, degenerative and cystic nodules showed less activity and hyperplastic solid nodules showed more activity than normal tissue.We concluded that although a Tl scan cannot differentiate between benign and malignant tumors statisfactorily, it is nevertheless useful for determining surgical indication, as the case showing Tl accumulation on the scan is malignant or benign tumor with poorly differentiated solid type and possibility of further growth and malignant change.

Immunohistochemical study of the medullary thyroid carcinoma with reference to C‐thyroglobulin reaction of tumor cells

Twelve cases of medullary thyroid carcinoma were investigated by the immunoperoxidase method using anti‐calcitonin, anti‐C‐thyroglobulin (C‐Tg, C cell‐immunoreactive thyroglobulin) and anti‐19S thyroglobulin antisera. Tumor cells as well as normal C cells revealed distinct immunoreaction for C‐Tg besides for calcitonin. In contrast to normal C cells, the tumor cells were stained more intensely by anti‐C‐Tg antiserum than by anti‐calcitonin antiserum. Furthermore, there occurred several tumors or some areas of tumors which showed strong response to anti‐C‐Tg antiserum but weak or no response to anti‐calcitonin antiserum. Thus, medullary carcinoma cells synthesized far greater amounts of C‐Tg than calcitonin. The small follicles were occasionally observed mingled in typical cell solid masses. They stored colloid‐like materials which were intensely immunoreactive to C‐Tg but nonreactive to calcitonin. The specific immunoreaction patterns to anti‐C‐Tg and anti‐calcitonin antisera were also obtained on the ground materials of the amyloid. On the histogenesis of amyloids of medullary carcinoma, the C‐Tg could be the precursor of the fibrillar protein of amyloids and the component of the fibrillar protein also closely related to calcitonin.

Myelofibrosis Secondary to Renal Osteodystrophy

A hemodialyzed women with secondary hyperparathyroidism who recovered well from myelofibrosis after a total parathyroidectomy with autotransplantation of parathyroid tissue to the forearm (PTx) is described. Before the operation, she had received regular transfusions to maintain an adequate hematocrit even under recombinant human erythropoietin (rhEpo) therapy. She showed splenomegaly and leukoerythroblastosis was present in her peripheral blood. A bone marrow biopsy and bone marrow scintigraphy confirmed the diagnosis of myelofibrosis. After PTx, her hematocrit gradually increased without any transfusion. It has been maintained around 35% now 16 months since the operation. Her spleen has also gradually decreased in size. In addition, no leukoerythroblastosis has been found in the peripheral blood. Serial follow-up scintigraphy of bone marrow revealed a decline in extramedullary hematopoiesis. These findings indicated that her myelofibrosis was the result of secondary hyperparathyroidism, and that this complication is potentially reversible if accurate treatment is given. Physicians dealing with the end-stage renal disease should be aware of this complication to avoid additional transfusions.

Prediction of Bone Mass in Renal Hyperparathyroidism by Newly Developed Bone Metabolic Markers: Evaluation of Serum Levels of Carboxy-Terminal Pyridinoline Cross-Linked Telopeptide of Type I Collagen and Carboxy-Terminal Propeptide of Type I Procollagen

Abstract. Serum levels of the carboxy-terminal pyridinoline cross-linked telopeptide of type I collagen (ICTP) and the carboxy-terminal propeptide of type I procollagen (PICP) were measured in 95 patients with renal hyperparathyroidism who had undergone a total parathyroidectomy and autotransplantation of a small portion of the resected gland. The results were compared with the serum levels of other bone metabolic markers and bone mineral densities in the distal radius (R-BMD) and lumbar vertebrae (L-BMD), which were measured by dual energy x-ray absorptiometry and converted to the percentage of the mean value of sex- and age-matched healthy controls. The preoperative mean values of ICTP and PICP were 142.4 ng/ml and 187.8 ng/ml, respectively. Although the serum levels of PICP levels exceeded the normal range in 42.1% of the patients, those of ICTP exceeded it in all of them. The serum levels of ICTP correlated positively not only with those of tartrate-resistant acid phosphatase (TRACP), total alkaline phosphatase (ALP), and osteocalcin but also negatively with the values of %R-BMD and %L-BMD and seemed to manifest specifically the disturbance of bone metabolism. On the other hand, the serum levels of PICP correlated with those of ALP and TRACP but not with values of %BMDs. After surgery, the serum levels of ICTP decreased gradually, but those of PICP increased immediately up to peak values at 7 days and then decreased gradually after 14 days, reaching the normal range at 3 months. These changes in the bone metabolic markers seemed to reflect the change in bone metabolism that was converting from bone resorption to bone formation. The percent change in the PICP/ICTP ratio at 7 days correlated significantly with the percent change in R-BMD at 12 months, and it was suggested that postoperative bone gain might be predicted using a combination of postoperative changes in PICP and ICTP.

Evaluation of bone loss and the serum markers of bone metabolism in patients with hyperparathyroidism

Bone loss and the serum markers of bone metabolism were studied in 22 patients with primary hyperparathyroidism and 108 patients with renal hyperparathyroidism. The parameters of bone loss were bone mineral density in the distal radius and lumbar vertebrae, measured by dual energy X-ray absorptiometry, and bone mass index (ΣGS/D) and the metacarpal index, in the second metacarpal bone, measured by the digital image processing method. Alkaline phosphatase (AIP), intact osteocalcin (OC), and the carboxyterminal propeptide of type I procollagen (PICP) were measured as serum markers of bone formation, while tartrate-resistant acid phsophatase (TRACP) and the carboxyterminal pyridinoline cross-linked telopeptide of type I collagen (ICTP) were measured as serum markers of bone resorption. Bone loss and elevated markers of bone metabolism were observed both in patients with skeletal symptoms and in those without. Furthermore, the decrease in the cortical bone mass was more predominant than that of the trabecular bone. As markers of bone formation, AIP and OC seemed to be more sensitive than PICP, and as markers of bone resorption, ICTP appeared to be more sensitive than TRACP. Thus, a close correlation was observed between bone loss and the markers of bone formation and resorption.

Iodine-131 uptake in a patient with thyroid cancer and rheumatoid arthritis during acupuncture treatment

A patient with thyroid carcinoma had abnormal accumulation of I-131 in the areas of both feet and hands on whole body scan. The sites of abnormal accumulation of I-131 were similar to those on bone scintigraphy. The radiographic examination of the lesions showed characteristic findings of rheumatoid arthritis, and the presence of small gold needles for acupuncture treatment was demonstrated. There were no findings of bone metastases. Although the mechanism of accumulation of I-131 in this patient is unknown, interpreters of I-131 whole body scintigraphs should keep this case in mind when acupuncture treatment has been done. The authors can only speculate on a common blood flow mechanism for enhanced HMDP and I-131 uptake in this arthritic patient who had been treated by acupuncture.