Hepatic epithelioid hemangioendothelioma—report of three cases of a puzzling tumor

Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant vascular neoplasm with unpredictable clinical behavior. These lesions are frequently misdiagnosed owing to its non-specific symptomatology, ambiguous radiological features, and overlapping histomorphology. We report three cases of hepatic EHE, of which one was male and two were female patients. While all three patients presented with abdominal pain, the male patient gave an additional history of weight loss and was jaundiced. The radioimaging showed multiple nodules in the liver and two of the patients also had pulmonary metastasis. The biopsies of the liver nodules revealed a tumor composed of spindle, epithelioid, and stellate tumor cells, some with characteristic intracytoplasmic vacuolations/lumina surrounded by myxohyaline stroma. Some of these intracytoplasmic vacuoles/lumina showed erythrocytes, suggesting its vascular origin which was confirmed by CD31 and CD34 positivity. The article highlights the importance of histopathology and IHC in the precise diagnosis of EHE.

Prognostic factors for incomplete response in thyroid microcarcinoma: an analysis of initial response to therapy in 517 patients

ABSTRACT Objective: Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC. Subjects and methods: This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into "favorable" (excellent/indeterminate) or "unfavorable" (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup. Results: The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis. Conclusion: Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.

Ultrasonographical, clinical and histopathological features of 1264 nodules with papillary thyroid carcinoma and microcarcinoma based on tumor size

ABSTRACT Objective: We aimed to evaluate the patients diagnosed with papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) in terms of clinical, ultrasonographical (US) and histopathological features and their relationships with tumor size. Subjects and methods: We retrospectively evaluated 881 patients who underwent thyroid surgery in our clinic and diagnosed with PTC histopathologically were enrolled the study. Demographic characteristics, US findings and histopathological features were evaluated. Results: In total, 1264 nodules were identified in the 881 patients. The incidentality rates were higher in the PTMC group and also in the ≤ 5 mm group. In total multifocality rate was 32.9%, and was significantly higher in PTMC group than the PTC group. PTC and > 5 mm PTMC groups compared to PTMC and ≤ 5 mm groups respectively, were more aggresive histopathological features. Conclusions: Since the incidentality rates were found significantly more common in our patients with PTMC and those with ≤ 5 mm, ultrasonographic features of the nodules should be evaluated carefully and for cases which are suspicious with US, US-guided fine needle aspiration biopsy (FNAB) should be considered in order to make the correct treatment strategy. Also our study revealed that PTC and > 5 mm PTMC groups compared to PTMC and ≤ 5 mm groups respectively, have more aggresive histopathological features.

Relationship between BRAF V600E mutation and clinicopathological features of papillary thyroid carcinoma patients combined with chronic lymphocytic thyroiditis / 肿瘤研究与临床

Objective To investigate the relationship between BRAF V600E mutation and clinicopathological features of papillary thyroid carcinoma (PTC) combined with chronic lymphocytic thyroiditis (CLT). Methods The clinical data of 168 PTC patients combined with Hashimoto thyroiditis who received radical surgery treatment in Beijing Caner Hospital from November 2013 to July 2016 were analyzed retrospectively. Sanger sequence was used to detect the status of BRAF V600E mutation. Then the patients were divided into BRAF V600E mutation positive (the observation group) and the mutation negative group (the control group). The clinicopathological features between the two groups were compared. Results The proportion of gender, age, calcification, lymphatic metastasis and extra gland invasion incidence had no significant difference between the observation group and the control group (χ2= 0.234, 1.139, 0.650, 1.262 and 1.665 respectively, all P＞0.05). Moreover, the differences of tumor size, tumor shape and tumor number in both groups were statistically significant (χ2= 7.071, 3.877 and 6.968 respectively, all P＜ 0.05). Logistic regression analysis showed that there was no statistical difference between the patients with BRAF V600E mutation or without in tumor number and central lymph node metastasis ( OR= 0.263, 95 % CI 0.049-1.402, P=0.118; OR=2.152, 95 % CI 0.666-6.956, P=0.200). Conclusion BRAF V600E mutation has no significant effect on clinicopathological features of PTC patients combined with CLT.

Multifocal papillary thyroid microcarcinoma increases the risk of central lymph node metastasis / 中华内分泌外科杂志

Objective To investigate the predictive factors for central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma(PTMC).Methods A retrospective study including 2511 cases of PTMC admitted from Jan.2013 to Jan.2016 were enrolled in our study.Chi-square test was used in univariate analysis.Logistic regression analysis was applied for multivariate analysis.The relation between age,sex,tumor size,multifocality,thyroidal extension,nodular goiter and central lymph node metastasis is analyzed.Results Univariate analysis showed that age,sex,tumor size,multifocality,thyroidal extension and nodular goiter had statistical significance.Age less than 45(P＜0.001,x2=17.442);Male gender(P＜0.001,x2=17.029);Tumor size less than 5 mm (P＜0.001,x2=70.164.);Extrathyroid extension factor (P＜0.001,x2=63.197);Nodular hyperplasia factor (P=0.017,x2=5.611).Multivariate analysis showed there was a significant relationship between multifocality and the central lymph node positivity.The odds ratio (OR) was 1.587 in patients with tumor foci ≥2(P＜0.001).While OR increased sharply near to 3 in patients withtumor foci ≥3(OR=2.730).Tumor size(OR=1.926);Extrathyroid extension(OR=1.606).Conclusions Multifocalty,tumor size and thyroidal extension are the main predicative factors for central lymph node metastasis in PTMC.Among them,tumor foci ≥ 3 is an important predictor.Besides the conventional factors such as tumor size,thyroidal extension etc,multifocalty should also be taken into consideration.

Research progress of surgical treatment of multifocal and multicentric breast cancer / 肿瘤研究与临床

Multifocality and multicentric breast cancer (MMBC) has been attached remarkable importance.The diagnosis of MMBC is of great importance for breast cancer individualized management,particularly regarding the choice of surgical method.A discovery of MMBC may be verified decisions to perform a wider excision which will avoid the appearance of positive margins.As for the results of conservative surgery developed by MMBC,however,contradictory conclusions exist in the related documents.No general common has been reached.MMBC may also alter the solution of the axillary basin.

The Relationship between the High-Frequency Component of Accommodative Microfluctuation, Accommodative Lag and Accommodative Amplitude in Presbyopic Eyes

PURPOSE: To determine the relationship between the high-frequency component of accommodative microfluctuation (HFC) and accommodative lag in presbyopic eyes and how they affect the subjective accommodation power with other ophthalmic factors, such as pupil diameter and corneal multifocality. METHODS: Forty subjects (80 eyes) were included in this study, and the non-corrected distance and near visual acuity was measured and then converted to log MAR vision. The addition power for 33 cm near visual work was also measured and the accommodative power was measured by the push-up method. The HFC, accommodative lag and pupil size according to accommodative stimuli (-1.0 to -3.0 D) was measured by Speedy-i Autorefractor (Right Mfg Co., Tokyo). The corneal multifocality and corneal astigmatism was measured by corneal topography (TMS-4; Tomey, Erlangen, Germany). RESULTS: The mean age was 60.0 +/- 4.66 years (51-68) and there were 23 male and 17 female subjects (1.35:1). The HFC and pupil size showed no significant change according to accommodation demand, however, the accommodative lag showed a statistically significant increase (p < 0.001 by one-way ANOVA). Accommodative lag (-2.0 D) showed a statistically significant negative correlation with the subjective accommodative power, and the pupil size (0 D) showed a positive correlation with the subjective accommodative power. CONCLUSIONS: In presbyopia patients, the objective accommodative lag and initial pupil size showed a statistically significant relationship with subjective accommodative power. On the other hand, HFC, pupil size and corneal multifocality, alone may not be indicators to predict accommodative power, but these are important components to explain the dynamic aspect of accommodation.

Analysis of Clinicopathologic Factors Associated with Bilateral Thyroid Micro Papillary Carcinoma / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma is the most common malignant tumor originating from the thyroid. The recent increase in frequency of thyroid ultrasonography is increasing the diagnostic rate of thyroid cancer, especially of the small-sized cancer. The appropriate extent of surgery for thyroid micropapillary carcinoma is still under debate, and bilaterality of the tumor may be an important factor determining the extent. Therefore, this study analyzed the clinicopathologic factors related to tumor bilaterality in order to help decide the extent of treatment. METHODS: Subjects included 134 patients who received total thyroidectomy and central neck lymph node dissection at Wonju Christian Hospital under the diagnosis of thyroid micropapillary cancer from January 1(st), 1994 to December 31(st), 2009. The frequency of bilateral tumor among the subjects were studied, and the relationship between bilaterality and clinicopathologic factors, including patients' gender, age, tumor size, multiple mass in single lobe, capsule invasion, extrathyroidal extension, lymphovascular space invasion, central neck node invasion and lateral neck node invasion was analyzed. RESULTS: There were 32 cases (23.9%) of bilateral tumor. Statistically significant factors related to bilaterality included two or more mass in a single lobe, perithyroidal soft tissue invasion. CONCLUSION: When we plan thyroidectomy for thyroid micropapillary cancer, one cannot rule out the possibility of bilateral thyroid micropapillary cancer in patients with clinicopathologic factors related to bilaterality. Closer preoperative examination is thought to be required for such patients.

Analysis of the Clinicopathologic Characteristics of Multifocal Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma (PTC) is the most common malignancy that develops from the thyroid gland and its prognosis is quite excellent. One of the characteristic behaviors of PTC is that it often occurs at multiple foci. The purpose of this study was to investigate the clinicopathologic features and risk factors of multifocal papillary thyroid cancer. METHODS: A retrospective review was carried out on 624 patients with PTC and who underwent surgery from January 2005 to December 2007. Two hundred twenty-nine of them were found to have multiple tumor foci (≥2 foci). The risk factors that included gender, age at diagnosis, tumor size, capsular invasion, extrathyroidal extension (ETE), cervical lymph node (LN) involvement, the TNM classification, local recurrence and distant metastasis were comparatively analyzed between the solitary PTC and multifocal PTC groups. RESULTS: The enrolled patients were 59 male and 565 females. The mean age was 46 years (range: 15~77 years). Age (P=0.025), tumor size (P=0.027), capsular invasion (P<0.001), ETE (P<0.001) and cervical LN metastasis (P=0.002) were the significantly related factors for multifocal papillary thyroid cancer. However, gender was not significantly related with multifocality. CONCLUSION: The results of this study showed that multifocal tumors were significantly associated with age, tumors size, capsular invasion, ETE and cervical LN metastasis in patients with PTC. LN metastasis was mostly influenced by multifocality in the PTC patients. It seems certain that total thyroidectomy and formal central node dissection with postoperative adjuvant therapy are essential treatment for these patients, and closely surveying the nodal status is needed on the follow up of patients with multifocal PTC.

Prognostic Significance of Multifocal Tumor in Radical Prostatectomy / 대한비뇨기과학회지

PURPOSE: We investigate the impact of tumor multifocality on the biochemical recurrence rate after radical prostatectomy. MATERIALS AND METHODS: Data was collected from 525 patients who underwent radical prostatectomy for clinically localized prostate cancer from 2003 to 2007. We evaluated the potential associations of multifocality with various clinical and pathologic factors. The ability to predict extra-capsular extension(ECE) was tested by logistic regression models, whereas biochemical recurrence(BCR) was assessed via Kaplan-Meier analyses and Cox-hazard regression models. The BCR was defined as a level of serum prostate-specific antigen(PSA) of 0.2ng/ml or greater on consecutive evaluations. RESULTS: Multifocality was observed to be significantly associated with the presence of a high grade Gleason pattern(p=0.014), the pT stage(p< 0.001), ECE(p=0.005) and a positive surgical margin(PSM)(p=0.019). Moreover, it was the independent predictor of ECE on multivariate logistic regression analyses(p=0.039). However, although multifocality had a significant influence on biochemical recurrence on the Kaplan-Meier analyses (log rank test, p=0.019), only the PSA level and the Gleason score were significant predictors of BCR on the multivariated Cox-hazard analyses. CONCLUSIONS: Although multifocality was associated with adverse pathologic features, it had no significant effect on biochemical recurrence on the multivariated cox-hazard analyses.

The Incidence and Clinicopathologic Predictable Factors for Multifocality in the Patients Who had Radical Nephrectomy Performed for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: We aimed to assess the influence of the clinical and pathological factors on the multifocality of renal cell carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the records of 467 patients (mean age: 54.6 years) who underwent operation for renal cell carcinoma at this hospital between June 1995 and April 2004. We evaluated the pathologic stage, grade, cell type, the histological pattern, tumor necrosis, the tumor size and the features of multifocality. To determine the clinical significant factors related with multifocality in renal cell carcinoma, we used the chi square test and multiple logistic regression analysis. RESULTS: Of the 467 renal cell carcinomas, 27 cases (5.8%) had multifocal malignant nodules. The average size of the multifocal renal lesions was 17x12x9 mm. The incidence of multifocality was statistically higher in the patients with stage pT3 disease than in those patients with stage pT1 or pT2 disease (p<0.001), and it was also higher for those patients with nuclear grade 3 or 4 than for those patients with nuclear grade 1 and 2 (p=0.005). Only the stage had significant correlation with multifocal disease when performing multiple logistic regression analysis. CONCLUSIONS: Our results suggest that the primary tumor stage is a risk factor for multifocality in the patients with renal cell carcinoma. Therefore, more precise preoperative staging of the primary tumor is required in case of performing nephron sparing surgery.

Less than 0.5 cm Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: The authors analyzed the characteristics of papillary thyroid microcarcinomas less than 0.5 cm in diameter to investigate an optimal extent of surgical resection. METHODS: Between October 1994 and October 2003, out of 635 cases of papillary thyroid microcarcinomas, 229 cases less than 0.5 cm in diameter were reviewed retrospectively to analyze their clinical and pathological characteristics. RESULTS: Mean diameter of the carcinomas was 3.9±1.2 mm for carcinomas less than 0.5 cm in diameter (group 1) and 7.7±1.4 mm for carcinomas between 0.5 and 1.0 cm in diameter (group 2). Total thyroidectomy, subtotal thyroidectomy, lobectomy & isthmectomy in group 2 were carried out in 308 (75.9%), 72 (17.7%) and 26 (6.4%) cases. Follow by group 1 were carried out in 109 (47.6%), 84 (36.7%) and 36 (16.7%)cases respectively. Between the two groups, perithyroidal invasion was 29.3% and 49.0%, multifocality was 24.9% and 32.8%, bilaterality was 13.1% and 21.4%, lymph node metastasis was 10.1% and 18.3% respectively with each data showing statistical significance (P<0.05). Completion thyroidectomy was carried out in 14 cases, of which 8 cases revealed carcinomas in the residual thyroid lobe. The group 1 required completion thyroidectomy more than the group 2 (P=0.026). There were less cases of lymph node metastasis among the group 1. Nine out of the 36 cases (25%) of the group 1 which underwent lobectomy & isthmectomy needed completion thyroidectomy, among them 6 cases (66.7%) revealed papillary carcinoma in the residual thyroid lobe. CONCLUSION: Micropapillary cancer was discovered more frequently by increasing the use of ultrasonography. Multifocality, bilateraluty and perithyroidal invasion were observed higher in group 2 rather than group 1. However, the relation between these facts and prognosis will need long term follow up.

Completion Thyroidectomy in Patient with Differentiated Thyroid Cancer Who Initially Underwent Ipsilateral Operation / 대한내분비학회지

BACKGROUND: In some instances, thyroid cancer may be diagnosed only after resection of a putative or suspected benign nodule. In these cases a complete thyroidectomy is usually recommended to prevent recurrence. We analyzed the frequency of malignancy in the contralateral lobe after a complete thyroidectomy, and assessed the factors that may predict the presence of a malignancy, which might necessitate a complete thyroidectomy. METHODS: Between 1995 and 2001, 65 patients, who initially underwent a lobectomy and isthmectomy, but were finally diagnosed with differentiated thyroid carcinoma, underwent complete thyroidectomies. Their mean age was 39.8 +/- 12.4 years, ranging, 14 to 71 years. After initial surgery, 45 proved to have follicular carcinomas, 18 papillary carcinomas, 1 medullary and 1 insular carcinoma. The mean tumor size was 4.0 +/- 1.8 cm, ranging from 0.3 to 8.5 cm. After a complete thyroidectomy, the presence of a tumor the at contralateral lobe was assessed according to clinical parameters and the pathological findings in the ipsilateral lobe. RESULTS: The first surgeries revealed tumor multifocality in 27 cases, perithyroidal tumor extension in 4 and lymph node metastasis in 1. On completion of the thyroidectomy, 22 of the 65 patients had a malignancy in the contralateral lobe. Age, sex, size or the pathological primary tumor type, were not associated with the presence of additional tumors at the contralateral lobe. Tumor multifocality at the first surgery was the only significant variable to predict the presence of a tumor in the contralateral lobe. CONCLUSION: When thyroid cancer is diagnosed after ipsilateral surgery, the only predictive factor for the presence of a contralateral tumor was multifocality. We believe that a complete thyroidectomy is mandatory in these cases.