Metaplastic breast carcinoma: series of cases and literature review

Introduction: Metaplastic breast carcinoma is a heterogeneous group of infrequent invasive carcinomas with aggressive behavior. It presents differentiation from the neoplastic ductal epithelium to squamous and/or sarcomatous mesenchymal component, through the epithelial-mesenchymal transition process, and may present morphology of epithelioid and fusiform cells, with possible cartilage, bone, lipomatous, fibromatous, smooth muscle or skeletal muscle differentiation, among others. Most of the cases present the triple-negative immunohistochemical profile. Objective: To report three cases of metaplastic carcinomas, with an emphasis on clinical and pathological aspects, in addition to conducting a literature review on this topic. Methods: The three cases were registered in the internal search system for reference services in breast pathology in São Paulo, between 2012 and 2019. For literature review, the keywords metaplastic carcinoma, breast, cancer, review, breast cancer subtype and pathological and clinical outcomes were used in PubMed. We found 154 articles, of which 42 were selected for full reading, based on the abstract and established inclusion criteria. After this initial selection, these articles were read and reviewed; nine articles that did not meet the inclusion criteria were excluded. Discussion: Three cases of metaplastic carcinoma with similar immunohistochemical characteristics have been reported. The first case is that of a 40-year-old patient with the diagnosis of metaplastic carcinoma producing a chondroid matrix with liposarcomatous and osteosarcomatous differentiation. The second case is that of a 50-year-old patient who presented with the final diagnosis for a fusocellular metaplastic carcinoma with lymph node metastasis. Finally, the third case described is that of a 59-year-old patient, who presented metaplastic carcinoma with chondroid differentiation. Conclusion: Metaplastic carcinoma is a rare and aggressive type of breast cancer, in which most of the patients have shorter survival and worse prognosis in relation to the other subtypes. More studies are needed in order to determine a gold standard treatment for this disease.

Morphological spectrum and epidemiological profile of ovarian tumours in black West African women at Lagos state university teaching hospital, Ikeja, Nigeria

Background: This study was done to evaluate the histological types, frequency and age distribution of ovarian tumours in Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos State. This study also aims to classify ovarian tumours in this centre according to the World Health Organisation (WHO).Methods: A retrospective, descriptive hospital study of all ovarian specimens that were sent to the department of pathology and forensic medicine, LASUTH between 1st January, 2011 and 31st December, 2019 was done. Relevant data composed of the age distributions and histopathological types were extracted from the departmental information system and filed documents. The data was analysed using the IBM-SPSS version 25.0.Results: There were 198 cases of ovarian tumours. The mean age at diagnosis of ovarian tumours was 34.6±15.3 years. Unilateral ovarian tumour was observed in 91.9%% of cases while bilateral disease was seen in 8.1%. Primary ovarian tumours constitute 97.0% of all diagnosed tumours of the ovary. Germ cell tumour was the most frequently diagnosed ovarian tumour; and teratoma was the most common, representing 91.2% of germ cell tumours and 47.0% of all ovarian tumours. Primary ovarian cancer peaked at the 6th decade of life and metastatic ovarian cancer was infrequently seen. Serous carcinoma is the most commonly diagnosed ovarian cancer.Conclusions: Ovarian tumour presents most frequently at the 4th decade of life, and germ cell tumour is the most common.

Histopathology of bladder carcinomas: an eight year retrospective study at Lagos state university teaching hospital, Ikeja, Nigeria

Background: This study was undertaken to evaluate the histological types, frequency, age and sex distribution of bladder carcinoma in Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos state. This study aims to classify bladder carcinoma in this centre according to the World Health Organisation/ International Society of Urological Pathology.Methods: An eight-year retrospective study of all bladder carcinomas specimens that were sent to the department of Pathology and Forensic Medicine, LASUTH between 1st January, 2011 and 31st December, 2018 was done. Relevant data consisting of the age and sex distributions as well as histopathological types were extracted from the departmental information system and filed documents. The data was analysed using the IBM-SPSS version 25.0.Results: There were 87 cases of bladder tumours, out of which 55 (63.2%) were bladder carcinomas. The mean age at diagnosis of bladder carcinomas was 56.9±13.9 years. Sex distribution has male to female ratio of 1: 1. Urothelial carcinoma predominates as the most common histological type.Conclusions: Bladder carcinoma presents most frequently at the 5th decade of life, with a slight male preponderance.

WT1 expression as a potential biomarker of malignancy in canine breast tumor / La expresión de WT1 como un biomarcador potencial maligno en un tumor de mama canino

SUMMARY: Veterinary oncology is very important nowadays to get a better understanding of human carcinogenesis. Estrogen receptor, progesterone receptor and Human Epidermal Growth Factor receptor 2 are frequently evaluated by immunohistochemistry (HIC) in human breast tumor. WT1 is an oncogene, its overexpression has been detected in leukemia and diverse solid tumors like breast cancer, lung cancer and mesothelioma in humans. WT1 expression was evaluated in 15 canine breast tumors (CBT) diagnosed by histopathological analysis to find its relationship with neoplasia and malignancy. IHC and RT-PCR were performed in CBT tissues. Fisher´s test was used to analyze WT1 relationship with malignancy. Of the 15 tumors, 9 (60 %) were diagnosed as benign and 6 (40 %) were malignant. With IHC, WT1 expression was positive only in biopsies diagnosed as malignant. Expression of WT1 by RT-PCR was detected in 14 of the 15 tumors (93.33 %) as well as in control healthy mammary gland. Clinical significance: This study describes for the first time a close correlation between CBT and a positive result for WT1 expression with IHC; hence, it can be used as a biomarker for this neoplasia and as an indicator of malignancy. RT-PCR analysis also showed to be good option to detect WT1 expression. These results will be useful to further investigations to elucidate WT1-related signaling pathways in CBT. Also to know molecules that regulate the translation of this protein as a marker for tumor progression.

RESUMEN: La oncología veterinaria es muy importante hoy en día para comprender mejor la carcinogénesis humana. El receptor de estrógeno, el receptor de progesterona y el receptor 2 del factor de crecimiento epidérmico humano se evalúan con frecuencia mediante inmunohistoquímica (HIC) en tumores de mama humanos. WT1 es un oncogén, su sobreexpresión se ha detectado en leucemia y en diversos tumores sólidos como el cáncer de mama, cáncer de pulmón y mesotelioma en humanos. La expresión de WT1 se evaluó en 15 tumores de mama caninos (TCC) diagnosticados mediante análisis histopatológico para encontrar su relación con la neoplasia y la malignidad. IHC y RT-PCR se realizaron en tejidos CBT. La prueba de Fisher se utilizó para analizar la relación de WT1 con la malignidad. De los 15 tumores, 9 (60 %) fueron diagnosticados como benignos y 6 (40 %) fueron malignos. Con IHC, la expresión de WT1 fue positiva solo en biopsias diagnosticadas como malignas. La expresión de WT1 por RT-PCR se detectó en 14 de los 15 tumores (93,33 %), así como en el control de la glándula mamaria sana. Importancia clínica: este estudio describe por primera vez una estrecha correlación entre la TCC y un resultado positivo para la expresión de WT1 con IHC; por lo tanto, se puede utilizar como un biomarcador para esta neoplasia y como un indicador de malignidad. El análisis por RT-PCR también demostró ser una buena opción para detectar la expresión de WT1. Estos resultados serán útiles para futuras investigaciones para dilucidar las vías de señalización relacionadas con WT1 en la TCC. También para conocer moléculas que regulan la traducción de esta proteína como marcador de progresión tumoral.

Correlation Study on Clinical Pathological Features and TCM Syndromes in Central Air Way Non-small Cell Lung Cancer / 中国中医药信息杂志

Absctact: Objective To discuss the correlation between the TCM syndromes and the clinical pathological features of central air way non-small cell lung cancer.MethodsTCM syndromes were determined through inquiry and physical examination for 109 cases of lung cancer patients. Remaining specimens after excision and routine pathological examination were under HE staining for pathological diagnosis and study. The correlation between the TCM syndromes and the clinical pathological features was analyzed.ResultsThe histological types of central airway non-small cell lung cancer comprised squamous cell carcinoma (69/109, 63.3%), salivary type carcinoma (27/109, 24.8%), adenocarcinoma (10/109, 9.2%) and other rare carcinomas (adenosquamous, 2/109, 1.8%; sarcomatoid carcinoma, 1/109, 0.9%). The clinical and pathological features showed that the elderly, male, smoking patients most commonly suffered from squamous cell carcinoma, while the young, female, non-smoking patients suffered from salivary type carcinoma most frequently. The distribution characteristics showed that the qi-yin deficiency syndrome was most common in squamous cell carcinoma and salivary type carcinoma, accounting for 41.4% (29/70) and 40.7% (11/27) respectively; qi-deficiency and phlegm-dampness syndrome was most common in adenocarcinoma, accounting for 50.0% (6/12). TCM syndrome types were closely related to sex, to smoking history, and to Karnofsky score respectively, with statistical significance (P<0.05,P<0.01). The qi-yin deficiency syndrome was common in male, smoking patients, while the qi-deficiency and phlegm-dampness syndrome and yin-deficiency and heat-toxin syndrome were common in female and non-smokers. The qin-yin deficiency syndrome was common in patients of Karnofsky score≥60, and qi-deficiency and phlegm-dampness syndrome was most frequently found in <60 scores group.Conclusion The histological types of central air way non-small cell lung cancer are related to age, gender and smoking history of patients. Patients with different ages, genders and smoking histories distribute differently in TCM syndrome.

Clinically localized type 1 and 2 papillary renal cell carcinomas have similar survival outcomes following surgery / Los carcinomas papilares de células renales tipo 1 y 2 localizados clínicamente tienen resultados de supervivencia similares después de la cirugía

Propósito Se intentó determinar la incidencia, hallazgos patológicos, factores pronósticos y resultados clínicos para pacientes con CCR papilar clínicamente localizado. Métodos Demográfico, Se recopilaron hallazgos clínicos y patológicos en todos los pacientes con CCRP sometidos a cirugía en cuatro centros médicos académicos. El punto final primario fue la supervivencia específica del cáncer (CSS). La supervivencia sin recaída (RFS) y la supervivencia general (OS) fueron puntos finales secundarios. Kaplan- Se obtuvieron estimaciones de Meier y se usaron modelos de regresión de riesgos proporcionales de Cox para evaluar predictores de mortalidad y recaída. Resultados Identificamos 626 CCPR, de los cuales 373 (60por ciento) fueron del tipo 1 y 253 (40 por ciento) fueron del tipo 2, con tres cuartas partes de todos los tumores siendo pT1. En comparación con los pacientes con tipo 1, aquellos con tipo 2 eran mayores (edad media: 63 frente a 61; (AU)

Purpose We aimed to determine incidence, pathologic fndings, prognostic factors and clinical outcomes for patients with clinically localized papillary RCC. Methods Demographic, clinical and pathologic fndings were collected on all patients with PRCC undergoing sur-gery at four academic medical centers. The primary end-point was cancer-specifc survival (CSS). Relapse-free survival (RFS) and overall survival (OS) were secondary endpoints. Kaplan­ Meier estimates were obtained, and Cox proportional hazard regression models were used to assess predictors of mortality and relapse. Results We identifed 626 PRCC, of which 373 (60 pertcent) were type 1 and 253 (40 pertcent) were type 2, with three-quar-ters of all tumors being pT1. Compared to patients with type 1, those with type 2 were older (mean age: 63 vs 61; (AU)

Clinicopathologic features of epithelial ovarian carcinoma in younger vs. older patients: analysis in Japanese women / 부인종양

OBJECTIVE: The purpose of this study was to clarify the clinical features of epithelial ovarian carcinoma (EOC) in younger vs. older patients in Japan. METHODS: We collected data on 1,562 patients with EOC treated at multiple institutions in the Tokai Ovarian Tumor Study Group, and analyzed them retrospectively. All patients were divided into 2 groups: group A (40 years old). The data were analyzed to evaluate prognostic factors and the distribution of features in each group. Patients were subjected to univariate and multivariate analyses to evaluate overall survival (OS). RESULTS: The median follow-up time was 45.1 months (range, 1 to 257 months). Patients in group A had a significantly higher rate of stage I disease (67.3% vs. 42.6%, respectively; p<0.001) and the mucinous type (36.7% vs. 13.5%, respectively; p<0.001) than those in group B. There was a significant difference of OS between the 2 groups (p=0.013). However, upon stratification according to the stage, there were no significant differences in the OS between the 2 groups (group A vs. B: stage I, p=0.533; stage II-IV, p=0.407). Multivariate analysis revealed that younger age was not an independent prognostic factor for OS. CONCLUSION: On the basis of our data, younger patients had a different clinical profile than older patients, particularly regarding the stage of the disease and pathological distribution; however, they showed a similar long-term prognosis, even upon stratification according to the stage.

Clinicopathological analysis of ovarian tumors in perimenopausal women: A study in a rural teaching hospital of eastern India.

Introduction: Ovarian tumors are important in perimenopausal women as they are more likely to be malignant. Aim: The aim was to study the various histological pattern of ovarian tumors and their clinical presentation in perimenopausal age group. Materials and Methods: The study was carried out in the departments of Gynaecology and Obstetrics and Pathology in a teaching hospital for two years from June 2007 to May 2009. All patients presented with ovarian tumors of perimenopausal age group (40- 50 years) were included. Detailed clinical information, radiological findings and histopathological reports were recorded. Results: A total 52 ovarian tumors were included in this study. Most common histological types were surface epithelial tumors (92.3%), out of which 54.2% were benign, 41.7% were malignant and 4.2% were borderline. Serous cystadenoma was the most common benign tumor and serous cystadenocarcinoma was the commonest malignant tumor. Abdominal discomfort was the commonest presenting symptom both in benign and malignant tumors (85.7% and 45.4% respectively). Most of the malignant tumors were presented in stage III (50%), followed by stage II (27.3%). Conclusion: In this: study, we found a relatively higher proportion of ovarian malignancies. So, any ovarian tumor in perimenopausal age group is more likely to be malignant and that require a thorough evaluation and management. Further research should be advocated in this field.

Trends in incidence and survival outcome of epithelial ovarian cancer: 30-year national population-based registry in Taiwan / 부인종양

OBJECTIVE: To investigate the changes of incidence and prognosis of epithelial ovarian cancer in thirty years in Taiwan. METHODS: The databases of women with epithelial ovarian cancer during the period from 1979 to 2008 were retrieved from the National Cancer Registration System of Taiwan. The incidence and prognosis of these patients were analyzed. RESULTS: Totally 9,491 patients were included in the study. The age-adjusted incidences of epithelial ovarian cancer were 1.01, 1.37, 2.37, 3.24, 4.18, and 6.33 per 100,000 person-years, respectively, in every 5-year period from 1979 to 2008. The age-specific incidence rates increased especially in serous, endometrioid and clear cell carcinoma, and the age of diagnosis decreased from sixty to fifty years old in the three decades. Patients with mucinous, endometrioid, or clear cell carcinoma had better long-term survival than patients with serous carcinoma (log rank test, p<0.001). Patients with undifferentiated carcinoma or carcinosarcoma had poorer survival than those with serous carcinoma (log rank test, p<0.001). The mortality risk of age at diagnosis of 30-39 was significantly higher than that of age of 70 years or more (test for trend, p<0.001). The mortality risk decreased from the period of 1996-1999 (hazard ratio [HR], 0.90; p=0.054) to the period after 2000 (HR, 0.74; p<0.001) as compared with that from the period of 1991-1995. CONCLUSION: An increasing incidence and decreasing age of diagnosis in epithelial ovarian cancer patients were noted. Histological type, age of diagnosis, and treatment period were important prognostic factors for epithelial ovarian carcinoma.

Relationships of Coagulation Factor XIII Activity with Cell-Type and Stage of Non-Small Cell Lung Cancer

PURPOSE: Factor XIII (FXIII), a thrombin-activated plasma transglutaminase zymogen, is involved in cancer development and progression through a triggered coagulation pathway. The aim of this study was to examine whether FXIII activity levels differed in non-small cell lung cancer (NSCLC) patients according to histological types and TNM stage when compared with healthy subjects. MATERIALS AND METHODS: Twenty-eight NSCLC patients and 28 normal controls who had been individually age-, gender-, body mass index-, smoking status-, and smoking amount-matched were enrolled: 13 adenocarcinomas, 11 squamous cell carcinomas, and four undifferentiated NSCLCs; four stage I, two stage II, 12 stage III, and 10 stage IV NSCLCs. FXIII activity was measured using fluorescence-based protein arrays. RESULTS: The median FXIII activity level of the NSCLC group [24.2 Loewy U/mL, interquartile range (IQR) 14.9-40.4 Loewy U/mL] was significantly higher than that of the healthy group (17.5 Loewy U/mL, IQR 12.6-26.4 Loewy U/mL) (p=0.01). There were no differences in FXIII activity between adenocarcinoma (median 18.6 Loewy U/mL) and squamous cell carcinoma (median 28.7 Loewy U/mL). NSCLC stage significantly influenced FXIII activity (p=0.02). The FXIII activity of patients with stage III NSCLC (median 27.3 Loewy U/mL, IQR 19.3-40.5 Loewy U/mL) was significantly higher than those of patients with stage I or II (median 14.0 Loewy U/mL, IQR 13.1-23.1 Loewy U/mL, p=0.04). FXIII activity was negatively correlated with aPTT in NSCLC patients (r=-0.38, p=0.04). CONCLUSION: Patients with advanced-stage NSCLC exhibited higher coagulation FXIII activity than healthy controls and early-stage NSCLC patients.

Correlation of C - erbB - 2 Status and Histologic Features in 1 6 3 Invasive Breast Carcinomas of baoji area / 中国基层医药

ObjectiveTo study the relationship between C-erbB-2 and estrogen (ER) and progesterone (PR) receptors, and the relationship between C-erbB-2, ER, PR with histologic grade. MethodsTo detect ER, PR and C-erbB-2 states by using immunohistochemical analysis and fluorescence in situ hybridization for C-erbB-2 in 163 unselected invasive breast carcinomas. ResultsC-erbB-2, ER ,PR were expressed in 21.5％ ,64.4％ ,44.2％ of 163 cases respectivly . 5 pure mucinous carcinomas , 3 tubular carcinomas and 1 micropapillary carcinoma were ER + ( 100.0％ ) 、C-erbB-2 - ( 100.0％ ) and PR + (40.0％ ,66.7％, 100.0％ ). C-erbB-2 was positive in 22.3％ of grade Ⅱ and 27.0％ of grade Ⅲ invasive ductal carcinomas and negative in all grade Ⅰ invasive ductal carcinomas.ER and PR expression were decreased significantly in C-erbB-2 + tumors compared with C-erbB-2 - tumors( ER,25. 7％ vs 75.0％ ; PR,25.7％ vs 49.2％ ). Although ER or PR expression is decreased in C-erbB-2 + tumors, a substantial proportion of them still express ER or PR. ConclusionC-erbB-2 overexpression or amplifcation was limited to a minority of invasive breast carcinomas. Tumour grade was an independent predictor for ER expression. ER was expressed in small number of high-grade and in large number of grade Ⅰ invasive ductal carcinomas. C-erbB-2 overexpression or amplification essentially was limited to grades Ⅱ and Ⅲ ductal carcinomas and correlated inversely with ER or PR expression.

The Influence of Cell Proliferation and Microvessel Density on the Recurrence of Synovial Sarcoma / 中国肿瘤临床

Objective: To study the prognostic significance of cell proliferation and apoptosis, MVD and clinicopathologi-cal parameters for the recurrence of synovial sarcoma. Methods: We analyzed the clinical and follow-up data of 56 synovial sarcoma patients without metastasis. RT-PCR was used to detect the subtype of SYT-SSX fusion gene. The expression of Ki67 and MVD was detected by immunohistochemistry. Univariate analysis was employed to analyze the influence of the above factors and clinicopathological parameters on the recurrence free survival and to explore the influencing factors for the recurrence of synovial sarcoma. Results: Of all the patients, 73.2% (41/56) had recurrence during the follow-up. The median recurrence free survival was 19.5 months. The recurrence free 1-, 2-, 3-, 4-, and 5-year survival rates after surgery were 45.0%, 41.0%, 34.0%, 28.0%, and 28.0%, respectively. Ki-67 labeling index (LI) was 19.98%±11.64% and MVD was 51.83±21.92 per ×400. There was no significant difference in apoptotic index (AI) between the two groups (P=0.607). Χ~2 analysis showed that histological type (P=0.000) and MVD (P=0.045) were significantly correlated with the recurrence of sy-novial sarcoma. Univariate analysis showed that Ki67 LI (P=0.009), histological type (P=0.012) and radiotherapy (P= 0.014) were significantly correlated with the recurrence free survival of synovial sarcoma patients. Sex (P=0.015), tumor lo-cation (P=0.411), tumor size (P=0.801), necrosis (P=0.486), MVD (P=0.454), chemotherapy (P=0.272), and apoptotic grade (P=0.899) were not correlated with the recurrence free survival of synovial sarcoma patients. Multivariate analysis re-vealed that higher expression of Ki67 (RR=1.944, P=0.045), radiotherapy (RR=0.482, P=0.04), and histological type (RR= 0.207, P=0.031) were independent risk factors for the recurrence of synovial sarcoma. Conclusion: The expression of Ki67, radiotherapy and histological type are important factors for evaluating the recurrence and prognosis of synovial sarcoma.

Clinical Course and Outcome of Thyroid Carcinoma in Childhood / 대한소아내분비학회지

PURPOSE: Thyroid carcinoma is rarely occurred in childhood and has a good prognosis despite high incidence of relapse. This study was undertaken to investigate clinical, histological characteristics and prognosis of thyroid carcinoma in childhood. METHODS: Eleven patients (6 males and 5 females) less than 21 years of age were enrolled in this study. They have been followed up for a mean duration of 6 years, ranging from 0.4 to 11 years. Clinical characteristics including age at diagnosis, sex, histological type, tumor size, metastasis, staging, treatment modality, outcome and prognosis with thyroid carcinoma in childhood were reviewed retrospectively. RESULTS: The mean age at diagnosis was 11.6+/-2.84 years. The predominant type of histology was papillary carcinoma (82%). Serum thyroglobulin levels were elevated up to 203.6+/-151.17 ng/mL in all patients at diagnosis. A thyroid scan using 99mTc-pertechnetate revealed cold (64%), warm (9%) and hot (18%) nodules. Seven patients (64%) had lymph node metastases, and five patients (45%) had pulmonary metastases at diagnosis. Total or near total thyroidectomy was performed in seven (64%) patients with local or distant metastases. Unilateral lobectomy was performed in four (36%) patients without metastases. Seven (64%) patients with local or distant metastatic lesions have been under radioiodine (131I) ablation therapy. Four (57%) out of seven patients improved, and three (43%) patients were persistent. CONCLUSIONS: Prognosis of thyroid carcinoma in childhood was good despite high incidence of local or distant metastasis. Patients with thyroid carcinoma should be diagnosed early because different treatment modalities and prognosis of patients with thyroid carcinoma could be determined by the presence of metastatic lesion and histological type.

Analysis of detection rate of thyroid malignant tumor before and after universal salt iodization and histological types / 吉林大学学报(医学版)

Objective To investigate and evaluate the detection and the variety of histology type constituent of the thyroid malignant tumor before and after universal salt iodization.Methods 1011 clinical pathological data of thyroid malignant tumor confirmed pathologically from 1961 to 2000 was retrospectively analyzed.The detection rate of thyroid malignant tumor,the constituent ratios of each histology type and the changes of age and sex distribution in main types of thyroid malignant tumor were determined.Results The total detection rate of thyroid malignant tumor after universal salt iodization (USI) (0.69%) were obviously increased compared with before universal salt iodization(0.46%,P40 years old) than before USI(≤40 years old).The incidence rates of thyroid malignant tumor in female patients were higher than male patients before and after USI.Conclusion The proportion and average age of thyroid malignant tumor increases after USI.The histological types of thyroid carcinoma have changes after USI:the proportion of PC increases obviously,the proportion of FC decreases accordingly.The average age of thyroid malignant tumor sufferers tends to increase and the peak ages of PC,FC and UC raise after USI.

Biological Characteristics of Thyroid Carcinomas

Thyroid carcinomas show a broad spectrum of neoplastic phenotypes with distinct molecular events. In a thyroid multistep tumorigenesis model for differentiated thyroid carcinomas of follicular cell origin(DTCs), normal thyrocytes are transformed to differentiated thyroid cancer and progress to poorly differentiated thyroid carcinomas(PDTCs) and ultimately anaplastic thyroid carcinomas(ATCs), through the progressive accumulation of alterations in genes related with cell proliferation and differentiation. PDTCs and ATCs lose expression of thyroid-specific genes such as thyroglobulin, TSH-R, sodium/iodide symporter(NIS) genes and thyroid specific transcription factors. These tumors unfortunately may grow rapidly, invade adjacent structures and spread to other parts of the body. Biological characteristics of thyroid carcinomas are also quite different according to histological types. Most of DTCs show favorable biological behavior and keep their differentiated functions such as iodine uptake and TSH responsiveness. Unlike the other human carcinomas, presence of regional lymph node metastasis does not alter outcome significantly but age at diagnosis profoundly affect biological behavior of DTCs. Many cases of ATCs appear to be associated with preexisting DTC and p53 mutation plays an important role in this terminal dedifferentiation. ATC is highly aggressive and lethal. Medullary thyroid carcinomas(MTCs) originate from calcitonin secreting C cell by point mutation of ret protooncogene. Some specific ret mutations(genotypes) predict the phenotypic expression of hereditary MTC, guiding the timing of thyroidectomy. Understanding of biological characteristics and behavior of thyroid carcinomas help us to make a logical decision for optimal timing and extent of surgical treatment and postoperative adjuvant therapy.

Results of Computed Tomography-guided Stereotactic Biopsy for Intracerebral Mass Lesions

OBJECTIVE: The diagnostic results are analyzed in a consecutive 55 patients undergoing computerized tomography(CT)-guided stereotactic brain biopsies. METHODS: There were 32 males and 23 females, and their mean age was 44.9(range 8 to 74) years. The biopsy procedure was generally carried out under local anesthesia. Three to four specimens were obtained with side-biting biopsy needles or cup biopsy forceps, usually from the enhancing portion or central hypodense area within the lesion. In 41 patients of brain tumor, 61% had frozen section guidance intraoperatively. The accuracy of targeting by postoperative CT scan was 95%. RESULTS: The lesions identified were neoplastic disease in 41 cases(75%), vascular disease in three, and infectious process in two. Forty-six cases revealed a definitive diagnosis, and 9 cases(16%) were classified as nondiagnostic. The stereotactic biopsy modified the clinical presumptive diagnosis in fifteen patients(28%), with changing the treatment modality. The final diagnosis was achieved in 8 of 9 failed biopsy patients based on the results from craniotomy(1), second biopsy(3), cerebrospinal fluid study(2), and clinical monitoring(2). The positive biopsy rate was 85% for brain tumors. In 10 cases of brain tumor, the histological studies from biopsied materials and resection tissue were identical. Comparison between the frozen section diagnosis and the final diagnosis based on the permanent sections revealed that they matched in 23(92%) cases. Five patients experienced transient neurological worsening after stereotactic biopsy. CONCLUSION: The representative tissue sampling and intraoperative assessment of sample quality by frozen section examinations can improve the diagnostic yield for the stereotactic brain biopsy. In a small number of patients who had inconclusive results, issues on repeating stereotactic biopsy or open biopsy, clinical and radiological follow-up, or choosing empiric therapy should carefully be considered.

Clinical analysis of 3rd Decade Male 47 Cases with Intracranial Tumors in Korea

The authors represented a clinical analysis of 3 rd decade male 47 patients with intracranial tumors who had been histologically confirmed after operation and biopsy at the department of neurosurgery of Capital Armed Forces General Hospital From Feb. 1985 to Jan, 1988. We classified the intracranial tumors according to Russell and Rubinstein's classification. The results were as follows: 1) Among the intracranial tumors, gliomas were found most frequently(40.4%), and followed by pituitary adenomas(19.2%), pinealomas(10.6%), osteomas(6.4%), medulloblastomas(4.3%), craniopharyngiomas(4.3%), blood vessel tumors(4.3%). Pituitary adenomas occupied 19.2% of all intracranial tumors and as a single entity these were the highest incidence. 2) Tumors of the pineal region constitutes 10.6% of intracranial tumors. It was relatively high incidence compared with other reports. 3) Intracranial tumors occurred more frequently in supratentorial region(85.1%). The most frequent location was sellar and parasellare region(23.4%), and followed by frontal(14.9%), parietal(12.7%), pineal gland(10.6%), temporal(8.5%), cerebellar region(8.5%) in order. 4) The most common duration of symptoms were within 3 months(42.6%). The main clinical symptoms and signs were headache(80.9%), nausea or/and vomiting(55.3%), papilledema(44.7%), so called symptoms triad of the brain tumor, and other ophthalmic symptoms, gait disturbance, motor dysfunction,cerebellar sign in order.

Clinical Observation of Intracranial Meningiomas(Computerized Tomographic Findings and Pathological Correlation)

Intracranial meningioma is one of the most easily detectable tumor in the preoperative period with the brain computerized tomographic(CT) scan. Although most of them are of benign nature, they present tendency to invade surrounding brain tissue and to recur in spite of complete surgical removal. Authors analysed the clinical features of 27 cases of histologically verified meningiomas and attempted to study the correlation between CT findings and histological types to predict their clinical invasiveness and aggressiveness. Female was predominated in occurance than male in the ratio of 17:10. Mean age of occurance was 40.5-year-old. The most frequent symptoms and signs were headache, papilledema and visual disturbance in order. The most frequent histological type was meningotheliomatous type(55.6%) which was followed by transitional(18.5%), fibroblastic(18.5%) and angioblastic(7.4%) types. In the finding of the brain CT scan, perifocal brain edema was noticed in nearly almost cases and high density of the tumor mass in the precontrast CT scan was predominated in transitional and fibroblastic types. But, marked perifocal brain edema, irregular tumor margin, loss of homogeneity of the tumor density and marked contrast enhancement, which were considered to be more aggressive and invasive findings, were predominated in the meningotheliomatous and angioblastic types. So, these types seemed to be more aggressive and invasive than other types. Large cystic meningiomas were 14.8% in author's cases.