[Morphological characteristics of recurrent papillary thyroid carcinoma].

UNLABELLED: Papillary thyroid carcinoma is generally characterized by a favorable prognosis in patients after timely and adequate treatment. However, local tumor growth recurrences and regional and distant metastases may occur in 5-20% of cases posttreatment. OBJECTIVE: To comparatively analyze the morphology and cellular composition of papillary thyroid carcinoma in two patient groups with comparable clinical and morphological characteristics, but different in the long-term results of treatment. MATERIAL AND METHODS: Histological specimens from 17 papillary thyroid carcinoma cases with recurrent tumor growth after treatment and resurgery (an experimental group) and 18 control cases without recurrences were selected from the database of the Chernobyl bank. The morphological features of primary tumors were studied in both groups; the morphology of recurrent tumors was also investigated in the experimental group. RESULTS: The higher incidence of tumors with papillary structure and a focal component from high-columnar, clear, and oxyphilic tumor cells was found in a group with a poor prognosis (a local relapse and metastases in the regional lymph nodes after thyroidectomy, hormonal and radioiodine therapy. CONCLUSION: The found morphological features of recurrent papillary thyroid carcinoma may serve as a starting point for further establishing criteria for tumor resistance to radioiodine therapy and for substantiating indications for other high-technology treatments, including targeted therapy.

[Ya.L. Rapoport's pathomorphism study: the past and the present].

The paper considers problems in the study of the pathomorphism of human neoplasms.

[A rare case of concurrent follicular and columnar cell variants of papillary thyroid carcinoma].

The paper describes a rare case of concurrent two different histological (follicular and columnar cell) variants of papillary carcinoma in one thyroid with columnar cell metastases to the lymph nodes and femoral bone. There are morphological features of and differences in BRAF status in the cells of two variants of papillary thyroid carcinoma.

[Pathomorphism of rectal cancer during neoadjuvant chemoradiotherapy].

The pathomorphism of rectal cancer (RC) was studied in 99 patients who received neoadjuvant chemoradiotherapy using two drugs (5-fluorouracil and xeloda). A morphological study indicated the qualitatively similar manifestations of pathomorphism (tumor necrosis, inflammation, and sclerosis) which were more pronounced in the use of xeloda. Three degrees of the pathomorphism of RC have been identified: the tumor was unchanged, changed, and undetectable.

[Morphological features of papillary thyroid carcinoma with a focal tall-cell component].

The morphological features of papillary thyroid macro- and microcarcinomas of classical structure with the focal presence or absence of a tall-cell component were comparatively studied. Histological specimens of 55 neoplasms were examined in 53 patients. A trend was seen for the higher rate of regional metastasis in a group of tall-cell tumors. Additional studies of groups of patients matched for sex, age, and extrathyroid tumor extension are required to make a final conclusion on the metastatic potential and prognostic features of tumors with a tall-cell component. To solve this task, it is expedient to separate neoplasms with a focal tall-cell component from the bulk of classical papillary carcinomas.

[Papillary thyroid carcinoma from tall and columnar cells].

The paper analyzes the data available in the literature on the morphological and prognostic features of the relatively rare morphological types of papillary thyroid carcinoma from tall and columnar cells. It is shown that the poor prognostic tall cell variant may be successfully diagnosed in the cytological smears of preoperative fine-needle biopsy and by histological examination of surgically removed tumor tissue. The question of the borderline extent of tall cells in order to single out the tumor as an individual classification category remains open. Columnar cell carcinoma poses great difficulties in making cytological and histological diagnoses. The prognosis of nonencapsulated tumors is poor as compared with that of encapsulated analogs of this variant.

[Prognostic value of of the expression Ki-67, CD31, and VEGF in somatotropinomas].

Pituitary adenomas are benign, but 30-50% of patients do not achieve remission after treatment. The purpose of the study was to analyze the prognostic value of immunoexpression of the proliferation marker Ki-67 and the angiogenetic factors CD31 and VEGF in somatotropinomas. Ki-67, CD31, and VEGF were immunohistochemically studied in the samples of 52 somatotropin-removed samples; medical records were used to analyze the outcome of treatment in the early and late postoperative periods. Ki-67 immunoexpression proved to be significantly higher in the patients who had not achieve remission both in the early (p = 0.042) and late (p = 0.012) postoperative period than in those who had achieved remission and in patients who were resistant to postoperative treatment with somatostatin analogues (p = 0.040) than in those who were sensitive to therapy. The immunoexpression of CD31 and VEGF was not associated with the outcome of treatment. Thus, high Ki-67 levels may be regarded as a poor postoperative prognostic factor in acromegaly.

[Morphological changes in thyroid tissue after preoperative fine-needle nodule biopsy].

The paper considers morphological changes in thyroid tissue after preoperative fine-needle biopsy of benign and malignant tumors at the above site in 5 patients. The found changes made the postoperative histological diagnosis of a tumor process difficult as; (a) there was total necrosis (2 cases of follicular tumor and papillary cancer from oxyphilic cells according to the data of a preoperative cytological study); (b) there were signs that mimicked those of invasive tumor growth in the proper fibrous capsules (2 cases of follicular adenomas); (c) there was abundant formation of fibrous tissue in the center of follicular adenoma. The paper discusses the rate and nature of the most common morphological changes induced by preoperative puncture biopsy.

[Recurring secondary hyperparathyroidism: case report].

The authors report a rare case of persistently recurring secondary hyperparathyroidism concomitant with chronic renal insufficiency. The patient underwent multiple surgical interventions (parathyroidectomy, implantation of parathyroid autograft into a forearm muscle, removal of hyperplastic autograft tissue). Results of clinical, laboratory, instrumental, and morphological studies are presented. Possible causes of relapses and problems of morphological diagnosis are discussed.

[The morphological and immunohistochemical features and malignancy potential of a hyalinizing trabecular tumor of the thyroid].

The paper considers the morphological features of a rare hyalinizing trabecular tumor of the thyroid, which is of follicular cell origin. The signs of invasive tumor growth into to the intrinsic capsule and its blood vessels were observed in 2 of 7 cases. There was a positive immunohistochemical reaction of tumor cells with antibodies to thyroglobulin and neuron-specific enolase and a negative one to calcitonin, galectin 3, cytokeratin 19, and HBME-1. The differential diagnosis of a tumor and papillary and medullary carcinomas of the thyroid, as well as its malignancy potential are discussed in the paper.

[Thyroid cancer with cribriform-morular structures: the problems of morphology and classification].

The paper considers the problems of the morphology and classification of cribriform-morullar cancer, a rare form of thyroid tumors of follicle-cell origin. The analysis of the clinical and morphological features of seven authors' observations and the data available in the literature makes it possible to formulate bases for singling out cribriform-morular cancer as an individual classification group of tumors requiring further investigations.

[Rare thyroid tumors: spindle-cell epithelial tumor and thyroid carcinoma with thymus-like differentiation].

The paper describes 2 cases of spindle-cell epithelial thyroid tumors (SETTLE) and carcinoma showing thymus-like differentiation (CASTLE). They are rare types of thyroid tumors and must be distinguished from medullary carcinoma, anaplastic carcinoma, synovial sarcoma and malignant teratoma. The presented cases show both common and unusual features as compared with the previously described tumors. CASTLE probably arises from ectopic thymus tissue. The further examination is needed to highlight the histogenesis of SETTLE, and to collect additional data on its aggressiveness and clinical outcome.

[Familial well-differentiated thyroid carcinoma].

Medical Research Institute of Radiology, Russian Academy Forty-eight cases of familial disease (24 families) (4.3%) were identified among 1,118 patients with well-differentiated thyroid carcinoma who had been either examined or treated at the Clinic of Medical Research Institute of Radiology (1995-2004). In 86% of the study group, papillary thyroid carcinoma (PTC) was associated with tumor of the identical histological pattern while the remaining families revealed association with follicular or medullary thyroid cancer. Carcinoma inheritable from mother was the most frequent (75%). No differences in manifestation, histological pattern, stage or clinical course were established following a detailed evaluation of clinico-morphological data on 43 familial and 172 sporadic (control) cases in both groups. The analysis pointed to a significantly higher incidence of concomitant thyroid pathology in the familial thyroid cancer group. Molecular-genetic study of RET-protooncogene and gene BRAF in 6 blood samples from PTC-bearers established RET-mutation (mother and daughter) in codon 891 (exon 15) G2673A (TCG->TCA). No mutation in BRAF was found.

[Frequency of RET/PTC rearrangement and somatic BRAF mutation in papillary thyroid cancer].

Frequency of RET/PTC rearrangement and somatic BRAF mutation was investigated in patients with papillary thyroid cancer (PTC) vis-a-vis relevant demographic and clinico-pathological features. The study group included 76 patients with a female/male ratio of 4.8:1; mean age - 45.7 +/- 9.7 yrs. BRAF mutation was identified in 49 (65%) (V600E--47, KSRWS600--1 and E585K--1). RET rearrangement was detected in 9 (12%): RET/PTC1--5, RET/PTC3--2, unspecified RET/PTC--1 and delta RET/PTC--1. It was age at diagnosis alone that proved to be consistently associated with BRAF mutations (p = 0.017). Younger tumor patients were mostly prone to RET/PTC rearrangement (p = 0.08). No correlation between mutation and clinico-pathological features was established.

[Assay of thyrocalcitonin in cervical lymph node using fine-needle washings for the diagnosis of disseminated medullary thyroid carcinoma]. / Opredelenie soderzhaniia tireokal'tsitonina v punktate limfaticheskikh uzlov shei dlia diagnostiki metastazov medulliarnogo raka shchitovidnoi zhelezy.

Fine-needle aspiration biopsy of cervical lymph nodes was carried out in 22 patients with suspected metastatic involvement with medullary thyroid carcinoma (MTS). It was followed by cytopathological examination of aspirates and assay of of thyrocalcitonin (TCT) in fine-needle washings. TCT determinations proved highly informative as well as significantly high in all seven cases of MTS involvement (26-8,484.87 pg/ml, mean 2,208 +/- 1,722 pg/ml).

[Radiogenic (Chernobyl) thyroid cancer]. / Radiogennyi (Chernobyl'skii) rak shchitovidhoi zhelezy.

Thyroid carcinoma is a documented medical consequence of the Chernobyl accident, but medicobiological and other aspects of this problem are not yet understood completely because Chernobyl thyroid carcinoma (CTC) is not a single nosological entity but an integrated notion including various groups of population of different age and sex, pollution of the territory, various histogenesis (A-, C-cells) and morphogenesis, latent period (minimal 4 years, maximal not yet known), variable clinical and morphological manifestations. Further CTC studies are needed on a special long-term program.

[Immunohistochemical and ultrastructural characteristics of papillary carcinoma of the thyroid in people living in regions contaminated with radionuclides]. / Immunogistokhimicheskaia i ul'trastrukturnaia kharakteristika papilliarnogo raka shchitovidnoi zhelezy u lits, prozhivaiushchikh v raonakh s radionuklidnym zagriazneniem.

Papillary thyroid carcinoma was studied in 12 patients who lived in the radionuclide polluted and nonpolluted areas. Neither immunohistochemical nor EM differences in the structure of the carcinoma between the contaminated and non-contaminated regions were found. Three structural variants were identified: classical, follicular and mixed, immunohistochemically having follicular-cell differentiation. Three EM types of cell were observed: dark, clear and intermediate.

[Cellular oncogenes and antioncogenes in thyroid tumors]. / Kletochnye onkogeny i antionkogeny v opukholiakh shchitovidnoi zhelezy.

Analysis of literature indicates that genetic mechanisms of thyroid tumor development are connected with two main classes of genes: oncogenes whose activation may stimulate tumor growth and anti-oncogenes which acquire oncogenic properties due to the loss of their function through point mutation or deletion. Protooncogene Ras mutation plays a role in the early events in tumor development. Restructuration of Ret and Trk oncogenes, overexpression of Met and Ras point mutations are characteristic for papillary thyroid carcinoma.

[Thyroid neoplasms in some regions of Russia after radiation accident in Chernobyl]. / Rak shchitovodnoi zhelezy u naseleniia nekotorykh oblastei Rossii posle avarii ha Chernobyl'skoi AES.

There is an increase of thyroid carcinoma incidence in regions contaminated after the Chernobyl accident as well as in Russia on the whole. The most considerable increase occurred in younger age groups of population. No difference in thyroid tumors structure was found in polluted with radionuclides and non-polluted regions.