Usefulness of preoperative serum calcitonin in patients with nodular thyroid disease without suspicious history or cytology for medullary thyroid carcinoma / Utilidade da calcitonina sérica pré-operatória em pacientes com doença nodular tireoidiana sem história ou citologia suspeitas para carcinoma medular de tireoide

OBJECTIVE: To evaluate the usefulness of preoperative serum calcitonin (sCT) in patients with nodular disease without suspicion of medullary thyroid carcinoma (MTC) in history or cytology. PATIENTS AND METHODS: sCT was measured before thyroidectomy in 494 patients with nodular disease who had no family history of MTC or multiple endocrine neoplasia type 2, and no cytological suspicion of MTC. RESULTS: Basal sCT was < 10 ng/mL in 482 patients and none of them had MTC. One patient with basal sCT > 100 pg/mL had MTC. Among the 11 patients with basal sCT between 10 and 100 pg/mL, MTC was diagnosed in only one. The two patients with MTC were submitted to total thyroidectomy, combined with elective lymph node dissection indicated exclusively based on hypercalcitoninemia, and sCT was undetectable after six months. CONCLUSIONS: Preoperative sCT is useful for the detection of sporadic MTC in patients with nodular disease, even in the absence of suspicious history or cytology.

OBJETIVO: Avaliar a utilidade da calcitonina sérica (sCT) pré-operatória em pacientes com doença nodular sem suspeita de carcinoma medular de tireoide (CMT) pela história e citologia. PACIENTES E MÉTODOS: Antes da tireoidectomia, sCT foi dosada em 494 pacientes com doença nodular, sem história familiar de CMT ou neoplasia endócrina múltipla tipo 2 e sem citologia suspeita para CMT. RESULTADOS: sCT basal foi < 10 ng/ml em 482 pacientes e nenhum possuía CMT. Um paciente com sCT basal > 100 pg/ml realmente possuía CMT. Dos 11 pacientes com sCT basal entre 10 e 100 pg/ml, CMT foi diagnosticado em apenas um. Os dois pacientes com CMT foram submetidos à tireoidectomia total com dissecção eletiva de linfonodos, indicada exclusivamente pela hipercalcitoninemia, e após seis meses apresentaram sCT indetectável. CONCLUSÕES: Em pacientes com doença nodular, mesmo sem história ou citologia suspeitas, a sCT pré-operatória é útil para detecção do CMT esporádico.

Kinase inhibitors for advanced medullary thyroid carcinoma

The recent availability of molecular targeted therapies leads to a reconsideration of the treatment strategy for patients with distant metastases from medullary thyroid carcinoma. In patients with progressive disease, treatment with kinase inhibitors should be offered.

Medullary carcinoma of the breast: ten year clinical experience of the Kuwait cancer control centre

Medullary carcinomas of the breast account for fewer than 7% of all invasive breast cancers. Some investigators include medullary carcinomas in the favourable histologic subtype, despite its aggressive histologic appearance. However, others fail to confirm its favourable prognosis. This was a retrospective analysis of sixty-one [61] cases of breast cancer cases diagnosed with Medullary Carcinoma, presenting to the Kuwait Cancer Control Center between 1995 and 2005. Median survival time was 122 months and the seven-year disease free survival was 82%. Overall survival rate was not assessed as no case died during the study period. No cases were metastatic from the start and only eight cases developed metastases, local recurrence or contralateral breast primary. 68.8% of the cases were Stage I or IIA [i.e. no lymph node affection]. There is no overt favourable prognosis of medullary carcinoma when compared to invasive ductal carcinoma. prognosis is more related to stage than histologic subtyping. The majority of cases were negative estrogen and progesterone receptor status and node negative

Carcinoma medular de la mama: comportamiento clínico terapéutico / Medullar carcinoma of the breast: clinical and pathological management

Se realizó un estudio de corte transversal sobre la incidencia y manejo del cáncer medular de mama en el Instituto Autónomo Hospital Universitario de Los Andes, Estado Mérida, Venezuela. Se revisaron 624 historias clínicas de pacientes femeninas con el diagnóstico de cáncer de mama en el período comprendido de 1999 hasta 2008. Se halló una incidencia del 0,8 por ciento. La edad promedio fue 47 años. El tamaño medio fue entre 1 cm-2 cm y >2 cm-3 cm al diagnosticarlas. El 80 por ciento de las pacientes se encontraban en estadios clínicos IIA y IIB 40 por ciento cada una. Los ganglios linfáticos axilares fueron microscópicamente positivos en 80 por ciento de las pacientes. El 60 por ciento de las pacientes fueron intervenidas quirúrgicamente, el 80 por ciento se sometió a tratamiento con quimioterapia y 40 por ciento a radioterapia y quimioterapia, el 100 por ciento de las pacientes viven y las operadas no presentan recidiva tumoral.

We realized across sectional study on the incidence and management about the medullar carcinoma and to determinate its incidence and management in our media. This disease was study and performed at the Instituto Autonomo Hospital Universitario de Los Andes, Mérida state, Venezuela. We review 624 clinical charts with breast cancer from 1999 to 2008. The 0.8 percent of incidence of this disease was found. The average age was 47 years old. Average size was between 1 cm-2 cm and >2 cm-3 cm. The 80 percent of the patients were at IIA and IIB clinical stages, 40 percent each one. Axillaries lymphatic lymph nodes were microscopically positive in 80 percent of the patients, 60 percent of the patients undergone surgery, 80 percent were treated with chemotherapy and 40 percent with radiotherapy and chemotherapy. 100 percent of patients still live and the surgically treated have no tumor recurrence.

Cáncer medular de tiroides esporádico de curso agresivo, en un adolescente varón / Madullary thyroid cancer in a 14 years old male: case report

Medullary thyroid cancer can appear sporadically or as part of a multiple endocrine neoplasia type 2A or 2B. In both conditions, it is associated with mutations of proto oncogene RET (rearranged during transfection). We report a 14 years old male presenting with a bone lesion in the skull followed by a hard cevical mass. A CAT scan showed an invasive thyroid nodule with involvement of regional lymph nodes , osteolytic lesions in skull, spine and ribs and liver metastases. Serum calcitonin was markedly elevated (9752 pg/ml, normal below 14 pg/ml). Fine needle biopsy showed a medullary thyroid carcinoma and the patient was subjected to a total thyroidectomy and radical cervical dissection. In the postoperative period the patient required calcium and vitamin D supplementation. Serum calcitonin 15 days after surgery was 11.692 pg/ml. Palliative radiotherapy was indicated for spine pain. A percutaneous gastrostomy was indication for nutritional support. The molecular study did not detect mutations of RET gene between exons 10 and 16.

Gammagrafía con receptores de somatostatina en un caso de carcinoma medular de tiroides / Somatostatin receptor scintigraphy for thyroid medullary carcinoma: a case report

La gammagrafía con radiotrazadores que tienen afinidad por los receptores de somatostatina se ha convertido en metodología eficaz para el diagnóstico y estadificación de los tumores neuroendocrinos. Se presenta un caso en el cual el procedimiento radioisotópico muestra su efectividad en la localización del tumor primario.

Somatostatin receptor scintigraphy has become an important tool for diagnosis and evaluation of neuroendocrine tumors. This case report shows about the importance of the radionuclide procedure for the localization of the primary tumor.

Carcinoma medular de tiroides: experiencia de 20 años / Medullary thyroid carcinoma: 20 years experience

Background: Medullary thyroid carcinoma (MTC) is a rare malignant tumor that arise from C cells. Surgical treatment and its results are controversial, so we decided to study it. Aim: To describe clinically MTC, treatment and outcomes in the long term. Material and Method: We retrospectively reviewed medical records of patients with MTC operated in our hospital between the years 1987 and 2007. We analyzed the cli-nical characteristics, treatment, morbidity and long-term follow up. Results: There were 24 patients operated with a mean age of 46.1 +/- 16.6 years. The main form of presentation was painless increased cervical volume (56.2 percent). In 15 percent this pathology was part of a MEN 2b. All of them have had a total thyroidectomy, which was extended in 50 percent of cases. The 35.2 percent were multifocal, 29.4 percent bilateral and 62.5 percent had metastatic lymph node involvement. Five patients remained higher calcitonin levéis in the postoperative period and 9 patients recurred clinically on average 4.5 years after surgery. The presence of persistent disease was significantly associated with hereditary MTC (p = 0.0088) and the clinical recurrence was significantly determined by the presence of not expanded total thyroidectomy (p = 0.0196). The probability of surviving more than 19 years was 66.6 percent (95 percent CI = 0.24 to 0.89). Conclusions: The MTC is a rare tumour and treatment of choice is surgery. The persistent disease is associated with hereditary MTC form, and the clinical recurrence is associated with not expanded total thyroidectomy. We recommend total thyroidectomy with central voiding and radical modified jugular dissection.

Antecedentes: El carcinoma medular de tiroides (CMT) es un tumor maligno poco frecuente, originado a partir de las células C. Su tratamiento quirúrgico y resultados son controvertidos, por lo que hemos decidido estudiarlo. Objetivo: Describir clínicamente el CMT, tratamiento y resultados a largo plazo. Material y método: Se revisaron retrospectivamente las fichas clínicas de pacientes con CMT operados en nuestro hospital entre 1987 y el 2007. Se analizaron las características clínicas, tratamiento, morbilidad y seguimiento a largo plazo. Resultados: Se operaron 24 pacientes, cuya edad media fue 46,1 +/- 16,6 años. La principal forma de presentación fue aumento de volumen cervical (56,2 por ciento). Un 15 por ciento formaba parte de una NEM 2b. A todos se les realizó una tiroidectomía total, ampliada en el 50 por ciento de los casos. El 35,2 por ciento eran multifocales, el 29,4 por ciento bilaterales y el 62,5 por ciento tenía metástasis ganglionar. Cinco pacientes mantuvieron niveles de calcitonina elevados en el postoperatorio y nueve pacientes recurrieron clínicamente, en promedio, a los 4,5 años. La enfermedad persistente se asoció significativamente con CMT hereditario (p = 0,0088) y la recurrencia clínica a tiroidectomía total no ampliada (p = 0,0196). La probabilidad de sobrevivir más de 19 años fue 66,6 por ciento (IC 95 por ciento = 0,24 a 0,89). Conclusiones: EL CMT es un tumor raro cuyo tratamiento de elección es la cirugía. La persistencia de enfermedad se asocia con la forma hereditaria, y la recurrencia clínica con la tiroidectomía total no ampliada, lo que nos hace recomendar una tiroidectomía total asociada a vaciamiento central y disección yugular radical modificada.

Sporadic medullary thyroid carcinoma: clinical data from a university hospital

INTRODUCTION: Medullary thyroid carcinoma may occur in a sporadic (s-medullary thyroid carcinoma, 75 percent) or in a multiple endocrine neoplasia type 2 form (MEN2, 25 percent). These clinical forms differ in many ways, as s-medullary thyroid carcinoma cases are RET-negative in the germline and are typically diagnosed later than medullary thyroid carcinoma in MEN2 patients. In this study, a set of cases with s-medullary thyroid carcinoma are documented and explored. PURPOSE: To document the phenotypes observed in s-medullary thyroid carcinoma cases from a university group and to attempt to improve earlier diagnosis of s-medullary thyroid carcinoma. Some procedures for diagnostics are also recommended. METHOD: Patients (n=26) with apparent s-medullary thyroid carcinoma were studied. Their clinical data were reviewed and peripheral blood was collected and screened for RET germline mutations. RESULTS: The average age at diagnosis was 43.9 years (± 10.82 SD) and did not differ between males and females. Calcitonin levels were increased in all cases. Three patients presented values that were 100-fold greater than the normal upper limit. Most (61.54 percent) had values that were 20-fold below this limit. Carcinoembryonic antigen levels were high in 70.6 percent of cases. There was no significant association between age at diagnosis, basal calcitonin levels or time of disease onset with thyroid tumor size (0.6-15 cm). Routine thyroid cytology yielded disappointing diagnostic accuracy (46.7 percent) in this set of cases. After total thyroidectomy associated with extensive cervical lymph node resection, calcitonin values remained lower than 5 pg/mL for at least 12 months in eight of the cases (30.8 percent). Immunocyto- and histochemistry for calcitonin were positive in all analyzed cases. None of the 26 cases presented germline mutations in the classical hotspots of the RET proto-oncogene. CONCLUSION: Our cases were identified late. The basal ...

Prognostic influence of clinical and pathological factors in medullary thyroid carcinoma: a study of 53 cases

OBJECTIVES AND INTRODUCTION: Medullary thyroid carcinoma, a neoplasia of intermediate prognosis and differentiation, does not always respond predictably to known treatments. This study aimed to correlate the clinical progression of surgically treated patients with clinical and pathological data. METHODS: A total of 53 patients were followed for 75 months (mean average) in tertiary-care hospital. The clinical status of patients at the end of the study period was characterized to determine correlations with a range of disease aspects. A value of p < 0.05 was considered statistically significant. RESULTS: Twenty-two patients (41.5 percent) were alive and disease-free at the end of the follow-up period; twenty-three patients (43.4 percent) had persistent disease; and eight patients (15.1 percent) had recurrent disease. Four patients (7.6 percent) died from medullary thyroid carcinoma with clinical and/or imaging evidence of neoplasia. The following aspects demonstrated statistically significant correlations with the final medical condition: positive initial cervical examination (p = 0.002); neoplastic extensions to the thyroid capsule (p = 0.004) and adjacent tissues (p = 0.034); cervical lymph node metastases (p < 0.001); diameter of neoplasia (p = 0.018); TNM (tumor, node and metastasis) Stage (p = 0.001) and evidence of distant and/or cervical diseases in the absence of a cure (p = 0.011). Through logistic regression, the presence of cervical lymph node metastases was considered an independent variable (p < 0.001). CONCLUSIONS: Clinical and pathological aspects of patients with surgically treated medullary thyroid carcinomas are predictors of disease progression. Specifically, even treated cervical lymph node metastases are significantly correlated with disease progression.

Early diagnosis of multiple endocrine neoplasia type 2B: a challenge for physicians / Diagnóstico precoce de neoplasia endócrina múltipla tipo 2B: um desafio para os médicos

BACKGROUND: The hereditary form of medullary thyroid carcinoma may occur isolated as a familial medullary thyroid carcinoma (FMTC) or as part of Multiple Endocrine Neoplasia 2A (MEN2A) and 2B (MEN2B). MEN2B is a rare syndrome, its phenotype may usually, but not always, be noted by the physician. In the infant none of the MEN2B characteristics are present, except by early gastrointestinal dysfunction caused by intestinal neuromas. When available, genetic analysis confirms the diagnosis and guides pre-operative evaluation and extent of surgery. Here we report four cases of MEN2B in which the late diagnosis had a significant impact in clinical evolution and, potentially, in overall survival...

A forma hereditária do carcinoma medular da tiróide pode ocorrer de modo isolado, o carcinoma medular da tiróide familiar (FMTC), ou como parte das neoplasias endócrinas múltiplas tipo 2A (MEN2A) e 2B (MEN2B). MEN2B é uma síndrome rara e seu fenótipo é usualmente, mas nem sempre, notado pelo médico. Na infância, nenhuma das características de MEN2B estão presentes, exceto pela disfunção gastrintestinal precoce, causada pelos neuromas intestinais. Quando disponível, a análise genética confirma o diagnóstico e orienta a avaliação pré-operatória e extensão da cirurgia. Neste artigo, apresentamos quatro casos de MEN2B, nos quais o diagnóstico tardio teve impacto significativo na evolução clínica e, potencialmente, na mortalidade em geral...

Neurofibroma de tireóide em uma paciente com neurofibromatose tipo 1 / Neurofibroma of thyroid in a patient with neurofibromatosis type 1

A neurofibromatose tipo 1 (NF1), também conhecida como doença de von Recklinghausen, é uma doença autossômica dominante com alto grau de variabilidade da expressão clínica, comumente envolvida na formação de tumorações na maioria das vezes de origem benigna, localizadas principalmente na região da cabeça e do pescoço, sendo a tireóide acometida raramente. Porém existe na literatura a associação com carcinoma medular da tireóide (CMT), necessitando sempre sua exclusão. Relatamos o caso de uma paciente com NF1, com um nódulo de tireóide não-funcionante e sintomas obstrutivos. Foi realizada ressecção cirúrgica da lesão, com achados histopatológicos compatíveis com neurofibroma em tecido tireoidiano. A importância desse caso deve-se não só à raridade dessa apresentação da NF1, mas também à possibilidade de associação desta com CMT, tumor agressivo com possibilidade de cura pela ressecção cirúrgica.

The neurofibromatosis type 1 (NF1), also known as von Recklinghausen’s disease, is an autosomal dominant disorder, with high degree of variability of clinical expression, usually involved with formation of tumors, with benign origin in the majority of cases mainly localized in the region of the head and neck and rarely incident in the thyroid area. However, the association with medullary carcinoma of the thyroid (MCT) exists in literature and needs to be excluded. We report a case of a patient with NF1, nonfunctional thyroid nodule and obstructive symptoms. Surgical resection of lesion was performed, with histopathologic findings compatible with neurofibroma in thyroid tissue. This case is relevant not only because of the rarity of the presentation of NF1, but also due to the likely association with MCT, an aggressive tumor that can be cured by surgery.

Cancer medullar da tireóide: revisão bibliográfica / Medulla thyroid cancer: a literature review

O carcinoma medular da tireóide é um tumor maligno raro com origem nas células parafoliculares da tiróide, tendo como principal produto secretorio a calcitonina. Representa 3-10% de todos os tumores tireoidianos e são responsáveis por um grande número de mortes em portadores de câncer da tireóide. Em 75 - 90% dos pacientes ocorrem de forma esporádica e nos demais casos é uma doença autossômica dominate com alto grau de penetrância e variabilidade de expressão, podendo fazer parte de três síndromes distintas: neoplasia endócrina múltipla (NEM) 2A, NEM eB ou CMT familiar. As diferentes formas clinicam do CMT principalmente as hereditárias, estão relacionadas com mutações no proto-oncogenese RET, as quais resultam em ativação constitutiva do receptor de membrana tirosina-quinase RET. A distinção entre estas formas é de extrema relevância clínica por causa das diferenças apresentadas entre formas é de extrema relevância clínica por causa das diferenças apresentadas entre elas em termos de prognóstico e pela necessidade de um rastreamento familiar, aconselhamento genético e seguimento das formas hereditárias. A eficiência do rastreamento genético, pela pesquisa de mutações no proto-oncogenese RET, esta bem estabelecida no diafgnóstico e na identificação de portadores assintomáticos das formas hereditárias de CMT permitindo uma intervenção cirúrgica precoce e efetiva, reduzindo a morbidade e mortalidade associada a esta doença.

PET imaging in differentiated thyroid cancer: where does it fit and how do we use it?

Positron emission tomography (PET) is a rapidly evolving imaging modality that has gained widespread acceptance in oncology, with several radionuclides applicable to thyroid cancer. Thyroid cancer patients have been studied most commonly using 18F-Fluorodeoxyglucose (FDG)-PET, with perhaps the greatest utility being the potential localization of tumor in differentiated thyroid cancer (DTC) patients who are radioiodine whole body scan (WBS) negative and thyroglobulin (Tg) positive. Also of value is the identification of patients unlikely to benefit from additional 131I therapy and identification of patients at highest risk of disease-specific mortality, which may prompt more aggressive therapy or enrollment in clinical trials. Emerging data suggest that PET/CT fusion studies provide increased accuracy and modify the treatment plan in a significant number of DTC cases when compared to PET images alone. However, studies documenting improvements in survival and tumor recurrence attributable to FDG-PET imaging in thyroid cancer patients are lacking. Specific case examples of thyroid cancer patients who appear to have benefited from FDG-PET imaging do exist, while less data are available in the setting of anaplastic or medullary thyroid carcinoma. This article reviews the utility and limitations of FDG-PET in DTC management, and offers practical recommendations.

Positron emission tomography (PET) é uma modalidade de imagem que vem evoluindo rapidamente e tem ganho ampla aceitação na oncologia em geral e no câncer da tiróide em particular, graças a uma série de radionuclídeos. Pacientes com doenças da tiróide têm sido estudados principalmente com 18F-Fluorodeoxiglicose (FDG)-PET, cuja maior utilidade talvez seja a de poder localizar tumor em pacientes negativos na pesquisa de corpo inteiro e com tireoglobulina positiva. Também é útil na identificação de pacientes que não devem se beneficiar de terapia adicional com 131I e de pacientes de alto risco que podem se beneficiar de terapias mais agressivas ou testes clínicos com drogas alvo-dirigidas. Dados recentes sugerem que a fusão PET/CT aumenta a acurácia e modifica o plano terapêutico de um número significativo de casos de CDT comparada com as imagens de PET apenas. Entretanto, ainda não existem estudos que documentem melhora na sobrevida e na recorrência decorrentes da imagem por FDG-PET em pacientes com câncer da tiróide. Existem exemplos específicos de casos de CDT que aparentemente se beneficiaram do FDG-PET, mas há menos dados relativos ao carcinoma anaplásico ou ao medular. Este artigo revê a utilidade e as limitações do FDG-PET no tratamento do CDT e oferece recomendações práticas.

Carcinoma familiar del tiroides no medular (CFTNM): características de presentación en 17 casos / Clinical features of 17 patients with familial non medullary thyroid carcinoma

Background: Papillary thyroid carcinoma can have familial aggregation. Aim: To compare retrospectively familial non medullary thyroid carcinoma (FNMTC) with sporadic papillary thyroid carcinoma (PTC). Material and methods: Retrospective analysis of medical records of patients with thyroid carcinoma. An index case was defined as a subject with the diagnosis of differentiated thyroid carcinoma with one or more first degree relatives with the same type of cancer. Seventeen such patients were identified and were compared with 352 subjects with PTC. Results: The most common affected relatives were sisters. Patients with FNMTC were younger than those with PTC. No differences were observed in gender, single or multiple foci, thyroid capsule involvement, surgical border involvement, number of affected lymph nodes and coexistence of follicular hyperplasia. Patients with FNMTC had smaller tumors and had a nine times more common association with lymphocytic thyroiditis. Five patients with FNMTC had local recurrence during 4.8 years of follow up. Conclusions: Patients with FNMTC commonly have an associated chronic thyroiditis, are younger and have smaller tumors than patients with PTC.

Variante oncocítica do carcinoma medular: relato de caso / Oncocytic variant of medullary thyroid carcinoma: case report

Tumores oncocíticos do sistema endócrino são um grupo de entidades raras descritas em diversos órgãos, incluindo a glândula tireóidea. O carcinoma medular pode excepcionalmente mostrar predomínio de células com alteração oncocítica, mas a imunorreatividade positiva para calcitonina costuma ser útil para o correto diagnóstico. Descrevemos o caso de paciente do sexo feminino, de 71 anos, com nódulo tireoidiano notado há 2 meses, de 5 cm, endurecido e sem ad'enopatia palpável significativa. A dosagem dos hormônios tireoidianos estava normal. A vascularização do nódulo, ao ultra-som com Doppler, era predominantemente central. O exame citopatológico revelou suspeita de neoplasia folicular com predomínio de células com alteração oncocítica. Foi realizada hemitireoidectomia. O exame histopatológico de congelação mostrou tratar-se de neoplasia folicular e a avaliação histopatológica do material incluído em parafina e imunoistoquímica concluíram tratar-se de carcinoma medular, variante oncocítica. A tireoidectomia foi totalizada em segundo tempo e a paciente recebeu dose terapêutica de 131I adjuvante, estando sem evidência de recidiva após 40 meses. O carcinoma medular deve ser considerado como diagnóstico diferencial nos casos incomuns de carcinoma tireoidiano com predomínio de células com alteração oxifílicas.

Postoperative Findings and Risk for Malignancy in Thyroid Nodules with Cytological Diagnosis of the so-called "Follicular Neoplasm"

BACKGROUND: Malignant follicular lesion is not differentiated from benign lesions cytologically. The objective of this study was to assess the rate and the risk of malignancy in thyroid nodules which were cytologically diagnosed as follicular neoplasm by fine-needle aspiration (FNA) cytology. METHODS: All the patients who had undergone surgery with cytological diagnosis of follicular neoplasm from January 1996 through December 2001 in Asan Medical Center were studied retrospectively. Patients' and nodule characteristics were analyzed for factors associated with the presence of cancer. Two hundred and fifteen patients (196 females, 19 males) were included and their mean age was 39.4 years (range: 12~76). RESULTS: About half of the patients (102 out of 215, 47.4%) had malignancy with 29 papillary carcinomas, 57 follicular carcinomas, 15 H rthle cell carcinomas and 1 medullary carcinoma. Previously suggested factors associated with risk for malignancy, such as male gender, large tumor size (> 4 cm) or age of patients (> 45 years), were not associated with increased risk. Diagnosis of H rthle cell neoplasia on FNA was also not associated with increased risk. Only the extremes in age of the patients (below 20 or above 60 years) were associated with increased risk for malignancy. CONCLUSION: In our findings, prevalence of carcinoma in thyroid nodule patients with cytological diagnosis of follicular neoplasm was much higher than those reported. Clinical characteristics, such as male gender, age and nodule size, are not useful predictors for the presence of malignancy. Thyroid nodules with cytological diagnosis of follicular neoplasm warrant immediate surgery.

Carcinoma medular de estómago / Gastric medullary carcinoma

El motivo de este trabajo es resaltar la importante población histiocítica presente en un caso de carcinoma medular de estómago. Este es un carcinoma poco diferenciado con abundante infiltrado linfoide, de buen pronóstico, homólogo a otros carcinomas medulares de mama, pulmón, región nasofaríngea, timo y glándula salival. Las técnicas histológicas usadas son: H-E, PAS, PAS-Alcian Blue, Alcian Blue, tricrómico de Masson, la técnica de impregnación argéntica para macrófagos de Del Río Hortega-Polak, y la impregnación argéntica para reticulina de Del Río Hortega. El carcinoma medular gástrico muestra una importante población linfocitaria T y B, y macrófagos dendríticos, plasmodiales, y gigantes multinucleados en estrecha relación con las células neoplásicas. Los resultados sugieren que el virus de Epstein-Barr (VEB) está asociado con el carcinoma medular gástrico

Hyalinizing trabecular adenoma--a case report with FNAC histologic, MIB-1 proliferative index and immunohistochemical findings.

Hyalinizing trabecular adenoma is a recently described benign thyroid tumor, almost exclusively occurring in females. The morphological features of this entity overlap with both papillary and medullary carcinoma to varying extent. This, in turn, creates a situation of serious diagnostic pitfall particularly for a false positive diagnosis of papillary carcinoma in fine needle aspiration (FNA) cytology. False consideration of medullary carcinoma is also possible by the unwary especially if staining for Congo red and/or immunostaining for calcitonin is not resorted to. At histologic level, the distinctive architectural pattern is however of great help and thus poses a much lesser danger of misdiagnosis. We relate here our experience in a recently encountered case of hyalinizing trabecular adenoma and describe detailed FNA cytologic and histologic findings along with immunohistochemical profile using a panel of eight monoclonal antibodies. The tumor proliferative potential has also been assessed using MIB-1 (Ki-67) immunostaining. The various pros and cons of diagnostic pitfalls are discussed.