Insular (Poorly Differentiated) Carcinoma of Thyroid / 대한내분비외과학회지

Insular carcinoma of the thyroid is a rare thyroid malignancy, and this was named in 1984 by Carcangiu when he described its characteristic histology. Histologically, insular carcinoma is characterized by uniform cells arranged in distinct nests or an insular pattern that contain variable numbers of small follicles. Clinically and morphologically, it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. This thyroid malignancy is distinctive, aggressive and often lethal. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic differentiated thyroid carcinoma, and most authors advise aggressive therapy, which can achieve pro-longed survival in some cases. We describe here a patient (a 42 years-old woman) who was managed with completion thyroidectomy after unilateral lobectomy of the thyroid with confirmation of the permanent pathology as insular carcinoma. I-131 ablation (175 mCi) was performed on the remnant thyroid tissues after follow-up of I~131 whole-body scanning.

Analysis of Clinicopathological Factors Affecting Local Recurrence of Colorectal Cancer after Curative Resection

PURPOSE: Local recurrence after curative resection of colorectal cancer has an important influence on both survival and quality of life. The ability to predict local recurrence after a curative resection of colorectal cancer may be useful for an intensive follow-up program and for a decision on adjuvant radiation or chemotherapy. The aim of this study was to analyze the factors affecting the incidence of local recurrence after a curative resection of colorectal cancer. METHODS: A retrospective review of 390 patients who had a curative resection for a primary colorectal cancer by a single surgeon at the Department of Surgery, Inha University Hospital, between June 1996 and July 2002 was done. The medical records of patients diagnosed with a local recurrence were reviewed. Local recurrence was defined as any recurrence within the field of resection, regardless of the presence or absence of distant metastasis, that was diagnosed by using colonoscopy with biopsy and/or radiologic imaging. RESULTS: Local recurrences were detected in 40 patients (10.3%). The gender distribution of patients with local recurrence was 24 males and 16 females with a mean age of 59.8 years. The median time to local recurrence was 15 months. The most common site of local recurrence was the anastomosis site, followed by a regional lymph node, the pelvicoperineal area, and the presacral area. Local recurrence was related to the depth of the primary tumor (P=0.027), lymphatics or vascular invasion (P=0.003), perineural invasion (P= 0.000), nodal status (P=0.000), and distant metastasis (P= 0.002). However, there was no statistically significant relation between local recurrence and primary tumor location (P=0.053), primary tumor size (P=0.982), tumor differentiation (0.256), and preoperative CEA level (P=0.481). CONCLUSIONS: The depth of the primary tumor, lymphatics or vascular invasion, and perineural invasion were significant clinicopathologic factors of local recurrence, but tumor location, tumor size, tumor differentiation, and preoperative serum CEA level were not.