Primary squamous-cell thyroid carcinoma - a successful treatment with five-year follow-up.

Squamous cell carcinoma is an extremely rare neoplasm of the thyroid (SCTC) that represents no more than 1% of all primary thyroid malignancies. We report a case of a 42-year-old woman with rapidly growing mass in the right lower neck, primarily diagnosed in fineneedle aspiration cytology as a low-differentiated carcinoma. After the surgery, exclusion of all the other possible primary tumour locations, and immunohistochemistry tests, the diagnosis of primary squamous cell carcinoma of the thyroid gland was established. Because of close surgical margins and metastatic neck node, the patient was referred to adjuvant postoperative irradiation. With five-year follow-up the patient is free of disease and still in very good condition.

Gene expression from bronchoscopy obtained tumour samples as a predictor of outcome in advanced inoperable lung cancer.

BACKGROUND: Several studies have shown the prognostic and predictive potential of molecular markers in combined therapy for lung cancer. Most of them referred, however, to operable early stage NSCLC. The aim of the present study is to correlate the expression of multiple mRNA markers in bronchoscopy obtained cancer specimens with clinical outcome of advanced lung cancer. METHODS: Bronchoscopy cancer specimens were taken from 123 patients with radiological diagnosis of advanced lung tumor. Out of 123 patients 50 were diagnosed with squamous cell cancer, 17 with adenocarcinoma, 12 with NOS, 32 with SCLC and one with large cell neuroendocrinal cancer. In 11 patients other tumours were diagnosed. The group was heterogeneous with respect to clinical stage, performance of the patients and treatment. Quantitative real time PCR was carried out by ABI 7900 HT machine, with Universal Probe Library (Roche) fluorescent probes. The genes selected for the analysis were ERCC1, EGFR, BRCA1, CSF1, CA9, DUSP6, STAT1, ERBB3, MMD, FN1, and CDKN1B. RESULTS: More than 50 ng of RNA (the amount considered sufficient for the analysis) was isolated in 82 out of 112 lung cancer specimens (73%), including 60/80 (75.0%) of NSCLC specimens and 22/32 (68,7%) of SCLC samples. The highest Cohen's κ coefficient for discrimination between small cell, squamous cell and adenocarcinoma was found for CDKN1B, CSF and EGFR1 (κ = 0.177, p = 0.0041). A multivariate Cox regression model has shown a significant impact of clinical stage (p<0.001, RR = 4.19), ERCC1 (p = 0.01, RR = 0.43) and CA9 (p = 0.03, RR = 2.11) expression on overall survival in a group of 60 patients with NSCLC. CONCLUSION: These results show the feasibility of multiple gene expression analysis in bronchoscopy obtained cancer specimens as prognostic markers in radiotherapy and chemotherapy for advanced lung cancer. A limiting factor was relatively high proportion of samples from which sufficient amount of RNA could not be isolated.

Prognostic value of lymph node metastases of differentiated thyroid cancer (DTC) according to the local advancement and range of surgical excision.

UNLABELLED: : In differentiated thyroid carcinoma (DTC) with primary tumor smaller than 1 cm, the routine central lymph node (LN) dissection is questioned, due to increased risk of post-surgery complications and lack of confirmed benefit. AIM: The analysis of prognostic significance of LN metastases, in DTC patients to verify the potential role of central neck lymphadenectomy on disease staging. MATERIALS AND METHODS: The group of 195 DTC patients, primarily operated between 2004 and 2005, was retrospectively analyzed. 184 patients after radical operation, with no distant metastases diagnosed before surgery, were included into analysis. LN metastases were observed in 55 of cases (28%). In 124 cases only dissection of central LN compartment was performed, in 36 patients also uni- or bilateral modified cervical lymphadectomy was carried out. In 24 patients with tumor limited to the thyroid gland without suspicious lymph nodes, the routine central lymph node dissection was not done. RESULTS: Median follow-up was 4 years. The 5-year overall and disease free survival standardized ratio were 100% and 95% respectively. The risk of LN metastases increased with the more locally advanced cancer. In the group of 124 patients, in whom only central LN dissection was performed, LN metastases were diagnosed in 15 cases (12%). No significant relation between multifocality and frequency of central and/or lateral LN metastases was noticed. Significant correlation between N feature and extrathyroidal invasion was observed (p = 0,0003). The presence of LN metastases was related to worsening of disease free survival from 99 to 90%. During the follow-up recurrence occurred in 6 (3%) cases. In 24 patients in whom only total thyroidectomy was done, no local or distant recurrence was observed. The assessment of early postoperative complications (hypoparathyroidism, paresis of vocal cords) indicated that the frequency of early calcium balance disturbances was significantly lower in patients in whom central LN dissection was not performed (p = 0,04) CONCLUSIONS: Our result indicate that in the early diagnosis of thyroid cancer, the occurrence of LN DTC metastases is rarer and was observed only in 12% of elective dissections of central LN node compartment, if no lateral dissection was indicated due to the lack of clinical suspicion. In DTC patients with tumor diameter <1 cm and no sonographical or inraoperative suspicion on LN involvement, routine central lymphadenectomy may be not obligatory.

[Oxyphilic and follicular thyroid tumors--the correlation between the cytopathologic diagnosis and the histopathologic examination]. / Oksyfilny i pecherzykowy guz tarczycy--korelacja rozpoznancytologicznych i histopatologicznych.

INTRODUCTION: Fine needle aspiration biopsy (FNAB) of the thyroid nodules generally allows to make the diagnosis and to choose the proper clinical management. In about 10% of cases cytopathologic features do not differentiate unequivocally benign and malignant lesions. In these cases the cytopathologic diagnosis of follicular tumor (FT) or oxyphilic tumor (OT) is most often made. MATERIALS AND METHODS: From 2001 to 2002 in our Department of Pathology the cytopathologic diagnosis of FT and OT was made in 102 and 25 cases respectively. Histopathologic verification was possible in 39 (38%) patients with FT and in 19 (76%) patients with OT. RESULTS: Histopathological diagnosis of neoplasm was made in 48.7% (19/39) FT and 42% (8/19) OT. The risk of carcinoma was 12.8% in FT and 16% in OT group (surgical treated cases only). CONCLUSIONS: These results show how difficult the diagnostics of follicular lesions in FNAB could be because of the frequent overlapping of the cytological features of benign and malignant lesions. Diagnosis of follicular tumor does not mean carcinoma. Majority lesions are begin non neoplastic on final histopathologic examination. The use of follicular/ oxyphilic tumor in cytological diagnostic instead of follicular neoplasm seems more advisable. However FNAB in the correlation with clinical data may select the patients for the surgical treatment or the further observation.