Reduced nm 23-H1 messenger RNA expression in metastatic lymph nodes from patients with papillary carcinoma of the thyroid.

The nm 23 gene product, which possesses nucleoside diphosphate kinase activity, is a possible mediator of cancer cell invasion and metastasis. It has been divided into two distinct gene products, nm23-H1 and nm23-H2. We have developed a method for detecting nm 23-H1 and nm 23-H2 RNA using the polymerase chain reaction, based on the amplification of complementary DNA copies of nm 23-H1 and nm 23-H2 RNA. Using this method, the nm 23-H1 and nm 23-H2 messenger (m)RNA levels in 35 thyroid papillary carcinomas, 11 metastatic lymph nodes from patients with thyroid papillary carcinomas, five thyroid follicular adenomas, and three normal thyroid tissue samples were studied. Both nm 23-H1 and nm 23-H2 mRNA were expressed ubiquitously in normal and malignant thyroid tissues. However, in metastatic lymph nodes no (3 of 11) or weak expression (8 of 11) of nm 23-H1 mRNA was observed, the extent of which was inversely proportional to the degree of cancer cell occupancy, whereas nm 23-H2 mRNA was expressed and the levels were similar to those in other tissue tested. These results show that nm 23-H1 only may play a role in cancer cell invasion and metastasis although the exact mechanisms involved have yet to be elucidated.

Oncogene expression in follicular neoplasms of the thyroid.

Oncogene expression has been found to be a potential marker for aggressive biologic behavior in certain tumors. We studied 21 follicular adenomas and 20 follicular carcinomas by immunocytochemistry utilizing specific monoclonal antibodies against HER-2/neu and c-myc oncogenes. Survival data were obtained from our institution's tumor registry. No expression of the HER-2/neu oncogene was found in the specimens studied. Cytoplasmic staining for c-myc was observed in 3 of 21 adenomas (14%) and 9 of 20 (45%) carcinomas (p < 0.05). The incidence of local, regional, and distant metastases was not significantly different in c-myc (+) and c-myc (-) patients. The c-myc oncogene is expressed more often in malignant than in benign follicular neoplasms of the thyroid, but its expression does not appear to be a good prognostic indicator.

Metastatic prostatic carcinoma presenting as an oncocytic tumor.

We discuss a 63-year-old man who presented with a metastatic tumor in an inguinal lymph node. By light microscopy, the tumor cells were characterized by a finely granular eosinophilic cytoplasm. A diagnosis of metastatic oncocytic carcinoma was made based on the results of an ultrastructural examination, which showed the cytoplasm of the tumor cells to be filled with mitochondria. Results of immunocytochemical studies showed positive reactivity for prostatic acid phosphatase and prostate-specific antigen. A transurethral resection of the prostate showed an oncocytic adenocarcinoma of the prostate, apparently the first of its kind, which was demonstrated to be the site of origin of the inguinal lymph node metastasis.

Duodenal neoplasms: predictive value of CT for determining malignancy and tumor resectability.

CT examinations of 25 patients with proved primary or metastatic duodenal neoplasms were retrospectively reviewed to determine if morphologic features seen on CT scans could be used to predict the benign or malignant nature of these neoplasms and to assess the effectiveness of using CT findings to predict tumor resectability. We studied 19 malignant and six benign tumors. Histologic proof was obtained by means of surgery in 20 patients and by endoscopic biopsy in five. CT features of tumor morphology were assessed in the 22 cases in which a duodenal tumor was seen on CT. These features included central necrosis, ulceration or excavation, and the location of the tumor with respect to the bowel wall. The specific morphologic features used to predict that a tumor was malignant included the presence of an exophytic or intramural mass, central necrosis, and ulceration. The only criterion used to predict that a tumor was benign was that the mass be entirely intraluminal. Whenever vascular encasement, invasion of contiguous organs other than the head of the pancreas, distant lymphadenopathy, or metastases were present, the tumor was predicted to be unresectable for cure. With the exception of three benign smooth muscle tumors, all tumors with one or more CT morphologic features indicative of a malignant neoplasm were malignant (n = 16). Three of four intraluminal masses were benign. In three cases of polypoid tumors smaller than 2 cm, a duodenal tumor was not seen on CT. Whenever extraduodenal disease was found (15 cases), the neoplasms were malignant. In the 22 cases in which a tumor was detected on CT, the sensitivity of using the presence of one or more morphologic features associated with a malignant neoplasm as a predictor was 94%; the specificity was 50%, and the accuracy was 82%. If the presence of any morphologic feature indicative of a malignant neoplasm was combined with the presence of any finding of extraduodenal disease, CT was 100% sensitive and 86% accurate for predicting that the tumor was malignant. CT appears to be reliable for predicting duodenal tumor resectability. On the basis of CT findings, 10 tumors were correctly predicted as being unresectable for cure, and 12 were predicted as being resectable; no surgery was performed in the remaining three cases. In conclusion, evaluation of the morphologic features of duodenal neoplasms is a sensitive, but nonspecific, method for predicting that a tumor is malignant.(ABSTRACT TRUNCATED AT 400 WORDS)

Surgical treatment of cervical spine tumors.

Of 40 patients with cervical spine tumor treated from 1980 to 1990, 24 had a primary tumor and 16 a metastatic tumor. Thirty-four patients were operated on through anterior and 5 through posterior approach. Preoperative neck pain was relieved and muscular strength of shoulder and arm increased after operation. Total excision methylmethacrylate or metal prosthesis replacement was used. Total excision of the lesion was emphasized for preventing the recurrence of the tumor. Indications and aims of the operation are discussed.

[The radioiodine-concentrating oncocytic thyroid carcinoma: a case report]. / Das radiojodspeichernde, onkozytäre Schilddrüsenkarzinom: Ein Fallbericht.

A patient with radioiodine-positive metastases to bone and lung of an oncocytic thyroid cancer is reported. A left-sided thyroidectomy had been performed nine years earlier. Histologically it had been a large capsular Huerthle-cell adenoma with regressive changes without signs of malignancy. During a recent operation for a disc prolapse in the lumbar spine a metastasis of an oncocytic thyroid cancer was found. A radioiodine scan showed high accumulation of 131I in the thyroid region, the lung and the lumbar spine. The rare finding of radioiodine uptake in oncocytic cancer is discussed.

Intracranial dissemination of an ACTH secreting pituitary neoplasm--a case report and review of the literature.

A 52-year-old woman developed recurrent hypercortisolism 3 yr after successful surgical treatment of Cushing's disease. At postmortem, eosinophilic pituitary tissue showing positive ACTH immunohistochemical staining was present in the frontal lobe and cerebellum but there was no tumor in the sella. In the absence of a pituitary tumor, extrasellar ACTH producing tissue could arise from seeding of the cerebrospinal fluid with tumor cells at the time of operation or from an atypical pituitary carcinoma. In this report we review the mechanisms of intracranial dissemination of pituitary tissue and ACTH-secreting pituitary carcinomas, including parasellar invasion, meningeal seeding, and cerebrospinal and hematogenous spread.

[Latent cancerous pathology of the thyroid]. / Skrytaia onkologicheskaia patologiia shchitovidnoi zhelezy.

Postmortem morphologic examination of the thyroid was performed in 122 residents of the Minsk Region, Byelorussian Republic. Various pathology underdiagnosed during life was found in 68%. Fourteen papillary carcinomas were detected in 11 (9.9%) of cases whereas 27 (22.1%) subjects revealed 46 follicular adenomas. Nodular goiter was established in 52.5%, thyroiditis--6.5% and cancer metastases--in 5.7% of cases. The male/female ratio for microcarcinoma was 8:3. All tumor-bearing subjects were over 41 years of age. Occurrence of the occult thyroid pathology in different regions of the country can be used to compare potential radiation and other hazards.

Diagnosis and treatment of cortical tumours of the suprarenal gland.

The authors report on their own groups of benign (20 patients) and malignant (14 patients) cortical tumours of the suprarenal gland. In both kinds of tumour the occurrence is higher in females. Adenoma occurred more often in the left adrenal gland and cancer in the right one. Some tumours manifested themselves by an increased production of suprarenal hormones, others were hormonally inactive and did not become manifest until the later stage of development. In the therapy of adenomas the classical lumbar approach through the 11th intercostal space is adequate, in the case of cancer and extended lumbotomy laparotomy or thoracotomy is necessary. The need of participation of other specialists in the treatment (endocrinologist, radiologist, oncologist, anaesthesiologist) is emphasized.

A null cell adenoma of the pituitary detected seven years after removal of a prolactinoma. Recurrence or de novo tumourigenesis?

We report an extremely unusual case of prolactinoma which emerged at recurrence as a null cell adenoma. A 53-year-old woman sought medical attention for progressive visual loss and headache. A pituitary tumour was detected by a computed tomographic scan, and hyperprolactinemia was noted. The tumour, removed by a transfrontal surgery, was a chromophobe adenoma, and immunohistochemically the adenoma cells were selectively positive for PRL, which indicated a prolactinoma. Postoperatively, her plasma PRL level was normalized. Seven years later, she noted blurred vision and again sought medical attention. A CT scan demonstrated recurrence of a pituitary tumour. On this occasion, however, she was not hyperprolactinemic. She underwent again a transfrontal resection of the pituitary tumour. Its histology was again a chromophobe adenoma, but the adenoma cells showed no positive immunostaining for any anterior pituitary hormone including PRL, which indicated a null cell adenoma. We have no clear explanation of the pathogenesis underlying her very unusual course. However, null cells (assuming that the original tumour was a mixed adenoma) left behind at the first surgery, or unidentified hypothalamic and/or pituitary derangements might possibly have been responsible for the recurrence. We learned from this patient that recurrent pituitary adenomas may not necessarily have the same endocrine features as did the original tumours. This information appears to make a valid clinical point, because if hormone levels alone are followed after pituitary surgery, recurrent pituitary tumours may be overlooked.

Characterization of conservatively resected renal tumors using automated image analysis DNA cytometry.

The DNA histograms of 57 conservatively resected renal tumors were studied using automated image analysis DNA cytometry (Leytas II). Forty-nine of the analyzed tumors were renal cell carcinomas, six were oncocytomas, one was an angiomyolipoma, and one was a renal cell adenoma. On the basis of their DNA histograms, diploid, tetraploid, and aneuploid tumors could be distinguished. Aneuploid tumors could be subtyped further according to the DNA content of the stem cell line as hyperdiploid, hypertriploid, or hypertetraploid. Eight of the tumors were characterized by a combination of diploid and hypertriploid stem cell lines. During a mean follow-up of 5 years, only the two patients with a pure hypertriploid tumor died of distant metastases. These results indicate that automated DNA image analysis cytometry is able to differentiate among several types of renal tumors with obviously different prognoses.

Follicular Hurthle cell tumors of the thyroid gland.

A clinicopathologic study of 153 cases of thyroid follicular Hurthle cell tumor (HCT) is presented. Follow-up, available in all cases, ranged from 5 to 26 years (median, 9 years). These neoplasms were divided into three categories on the basis of presence and degree of capsular and vascular invasion, pattern of growth (follicular, trabecular, or solid), nuclear atypia, and necrosis. The categories were benign (90 cases), indeterminate (35 cases), and malignant (28 cases). All the tumors classified histologically as benign or indeterminate behaved in a clinically benign fashion. Of the 28 tumors classified histologically as malignant, 20 had a clinically malignant behavior. At survival analysis, no clinical or pathologic feature among the carcinomas was found to correlate with a fatal outcome. It is concluded that histologic criteria alone can distinguish benign from malignant HCT and that clinical or pathologic feature cannot predict behavior among the malignant tumors.

Pediatric pituitary tumors.

This retrospective review of pediatric patients with pituitary tumors causing onset of symptoms by 17 years of age was done to define their pathological distribution, clinical presentation, treatment, and prognosis. Eighteen patients were evaluated and treated from 1979 to 1989. Five had Cushing's disease and 13 had prolactin-secreting tumors. The mean age at the onset of symptoms was 14.7 years, with a range of 7 to 17 years. The mean follow-up period was 4.6 years, and the series consisted of 15 girls and 3 boys. Four of the 5 patients with tumors secreting adrenocorticotropic hormone were girls. The five patients exhibited obesity, hypertension, and growth retardation. The mean age of this group of patients at diagnosis was 12.2 years, and all had intrasellar lesions removed by the transsphenoidal approach. Adenoma was documented in 4 cases by histopathology. There was complete resolution of the endocrinological and clinical abnormalities in each case. The group of patients with prolactinomas comprised 11 girls and 2 boys, and their mean age at diagnosis was 15.7 years. The girls exhibited either primary or secondary amenorrhea. Seven had macroadenomas and 4 had microadenomas. Nine of the 11 girls underwent transsphenoidal resection, and surgery failed in 6, based on hormonal or radiological data. The two boys had suprasellar tumor extension and required multiple surgical procedures plus radiation therapy for control of the tumor mass.

Imaging of adrenal metastases.

This paper discusses the application of CT, MR imaging, and 131I-6 beta-iodomethyl-19-norcholesterol scintigraphy in establishing the nature of incidentally discovered adrenal masses. It is concluded that CT and MR imaging can permit confident differentiation between nonhyperfunctioning adenomas and metastases in cases of incidentalomas that meet all the criteria of a nonhyperfunctioning adenoma. In cancer patients, fine-needle aspiration biopsy of lesions is, in general, essential because a definitive diagnosis of metastatic disease is crucial to disease management. MR imaging and norcholesterol scintigraphy are useful if a relative contraindication for fine-needle biopsy exists or when biopsy results are inconclusive in patients with a presumably benign lesion.

A case of adenocarcinoma of the lung associated with a neck mass and hypercalcemia.

The case of hypercalcemia secondary to metastasis to a benign parathyroid adenoma is reported. The patient had documented lung adenocarcinoma with multiple bone metastases and a mass in the lower anterior neck for at least 5 months before hypercalcemia and hypophosphatemia resistant to treatment developed. Autopsy revealed widespread metastatic disease including metastatic tumor invading a benign parathyroid adenoma. The analysis of four cases of metastatic cancer spread to a benign parathyroid adenoma reported previously revealed that two of them also had hypercalcemia during a late stage of the disease. There are data that the incidence of metastases to parathyroid gland might be as high as 11.9%, and the incidence of parathyroid adenomas in patients with cancer is significantly higher than in controls. The metastases to benign parathyroid adenomas might be another mechanism of hypercalcemia of malignancy.

Positron emission tomography of pituitary macroadenomas: hormone production and effects of therapies.

Positron emission tomography with [18F]fluorodeoxyglucose (FDG) was carried out in 24 patients with pituitary macroadenomas (32 studies) to assess the glucose utilization of these tumors in vivo. The adenoma metabolic index, which is the ratio of FDG uptake of tumor to a whole brain slice, was calculated. Comparisons were made between tumor uptake of FDG and hormone secretion and response to therapies. In each positron emission tomography study, the macroadenoma could be easily identified visually as an area of increased FDG uptake near the region of the sella. FDG uptakes were highest for nonfunctional adenomas, and the prolactin, growth hormone, and thyroid-stimulating hormone-producing groups displayed similar levels of glucose metabolism. The adenoma metabolic index for all tumors averaged 1.3, ranging from 0.3 for a thyroid-stimulating hormone adenoma to 3.5 for a nonfunctional tumor. Tumors did not exhibit metabolic rates that could characterize the type of hormone produced. Recurrent macroadenomas displayed metabolism similar to tumors not operated on, whereas irradiated adenomas showed lower glucose uptake than nonirradiated tumors. Drug therapy with bromocriptine or the long-acting somatostatin analogue octreotide also decreased the glucose utilization of the tumor. There was no correlation between the amount of hormone produced and the adenoma metabolic index when a group of tumors was analyzed. Patients scanned more than once, however, demonstrated changes in hormone levels that changed or did not change in parallel with tumor metabolism. Thus, positron emission tomography offers the potential capability for predicting and defining the growth of pituitary adenomas. This may be of particular value when plasma hormone assays and conventional imaging techniques prove inadequate for monitoring patient response to therapy.

[Atypical bone metastases in prostate cancer]. / Atypische Skelettmetastasierung bei Prostatakarzinom.

Two cases of prostatic cancer with single bone metastasis in the tibia are discussed. The intense uniform involvement of a solitary limb bone with high perfusion and blood pool activity in the 3-phase bone scan and the positive white blood cell scan (observed in one case) were not typical for a metastatic bone lesion. Conventional radiomorphology--lamellar, periosteal reaction, disseminated medullar sclerosis, no localized lesion--also led to other differential considerations such as osteomyelitis and malignant lymphoma, which could not be specified by CT and MRI. Even if there is no typical morphology in scintigraphic and radiologic imaging, biopsy should be performed to exclude bone metastasis in prostatic cancer.

Evaluation of adrenal masses in oncologic patients: dynamic contrast-enhanced MR vs CT.

The CT examinations, precontrast gradient echo MR images, and fast contrast enhanced dynamic MR studies were evaluated in 44 patients with 52 adrenal masses and known malignant disease of different origin. Morphologic features (size, shape, attenuation, contour, and enhancement) on CT scans, signal intensity on T2-weighted MR images, and patterns of enhancement on Gd-DTPA enhanced dynamic MR studies were analyzed in all patients. With dynamic contrast enhanced studies with prolonged imaging up to 15 min after Gd-DTPA, masses with moderate enhancement and complete washout after 10 min were considered as adenomas. Computed tomography and plain MR had a sensitivity of 0.71 and 0.96, a specificity of 0.75 and 0.88, and overall accuracy of 0.56 and 0.71, respectively. Simultaneous use of precontrast MR and dynamic contrast enhanced studies led to an accurate diagnosis in 88% (sensitivity = 1.0, specificity = 0.91) and thus should be considered in oncologic patients with undetermined adrenal masses.