Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Four patients with a histologically distinctive thyroid carcinoma--which recently has been referred to as poorly differentiated ("insular") carcinoma--are reported. This study confirms the previous conclusions that patients with this neoplasm often experience an aggressive clinical course, with focal recurrences and distant metastases common, which results in death in the majority of patients. Such aggressive behavior may occur even when the insular component accounts for only a small percentage of an otherwise well-differentiated carcinoma, as seen in one of our patients. After subtotal or total thyroidectomy, three of the four patients have experienced local recurrence (1) and metastases to lung (3), mediastinum (1), and bone (1). All three of these patients died within 2 years of the diagnosis of insular carcinoma. The remaining patient is alive without evidence of disease 1 year after total thyroidectomy. Histologically, this neoplasm is characterized by well-defined nests (insulae) that are composed of relatively small, uniform cells and sometimes associated with small, thyroglobulin-containing follicles. Tumor necrosis is often present. Insular carcinoma may comprise the entire neoplasm (2 patients) or be associated with well-differentiated follicular (1 patient) or papillary (1 patient) carcinoma. The rapid and often fatal course associated with insular carcinoma warrants aggressive treatment at the time of initial diagnosis, including total thyroidectomy and node dissection (if involved), as well as possible iodine-131, external beam irradiation and chemotherapy.
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PMID:Poorly differentiated ("insular") carcinoma of the thyroid gland: an aggressive subset of differentiated thyroid neoplasms. 319 48

Intrathyroidal thymoma is a rare tumor that occurs in the thyroid gland and has been reported as a low-grade malignant tumor. The present report describes a 59-year-old male patient with this tumor, who was treated with subtotal thyroidectomy followed by radiation and chemotherapy. The tumor was located in the lower pole of the left lobe and the isthmus of the thyroid, and it had invaded the thyroid parenchyma, thyroid capsule, adjacent connective tissue, and neck muscles. Continuity between the cervical thymus and the tumor was noted. Subsequently, the patient developed widespread metastases in the liver, lungs, bones, and lymph nodes without local recurrence. Histologic examination disclosed a solid growth of epithelial cells with squamous cell differentiation and keratinization. The tumor cells had an ill-defined cell border and large nuclei with large nucleoli. Moderate mitoses and slight necrosis of the tumor were seen. Immunohistochemical examination showed that the tumor cells were stained positively for keratin but not for calcitonin or thyroglobulin. There were infiltrations of lymphocytes in the tumor and fibrous stroma, and most of them proved to be T cells.
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PMID:Carcinoma of possible thymic origin presenting as a thyroid mass: a new subgroup of squamous cell carcinoma of the thyroid. 326 Jun 44

This study delineates tumor characteristics which predispose serum thyroglobulin (TG) to be undetectable in patients in spite of persistent or recurrent differentiated thyroid cancer. Three hundred seventy four thyroid carcinoma patients with completed thyroid ablation were investigated by means of conventional diagnostic procedures (131 iodine total-body scan, x-ray, TG determination) and, in addition, with high-resolution sonographic study of the neck. Sensitivity of TG for the detection of metastases amounted to 83% under TSH stimulation and 50% under thyroxine (T4) treatment. Specificity proved to be 95% under TSH stimulation and 99% under T4 treatment. Common features of the tumors associated with false-negative TG determinations (n = 16) were papillary histologic characteristics, manifestation in lymph nodes of the neck or mediastinum, and small size. It is therefore necessary for the early detection of persistent or recurrent papillary cancer metastases to perform in addition to 131 iodine scans high-resolution sonography of the neck in combination with the determination of TG serum concentrations under endogenous TSH stimulation.
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PMID:Clinical evaluation of tumor characteristics predisposing serum thyroglobulin to be undetectable in patients with differentiated thyroid cancer. 327 96

An unusual case of poorly differentiated carcinoma of the thyroid is reported. The tumor occurred in a 60-year-old man, who died with widespread metastases 5.5 years after primary treatment. The unencapsulated tumor measured 8 X 5 X 9.5 cm and was composed of columnar cells. Two to three mitotic figures per 10 high-power fields were present. The cells were thyroglobulin positive and not stained for calcitonin and carcinoembryonic antigen (CEA). The light microscopic appearance was similar to that of a metastasis from a carcinoma of the bowel. The authors conclude that columnar cell carcinoma is a separate type of thyroid carcinoma that shares the clinical properties of both follicular and papillary carcinoma and carries a poor prognosis. However, for practical purposes, the authors think that the tumor should be included in the category of poorly differentiated thyroid carcinomas together with the so-called insular carcinomas, mucoepidermoid carcinomas, and mucinous carcinomas.
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PMID:Columnar-cell carcinoma. Another variant of poorly differentiated carcinoma of the thyroid. 334 Dec 87

Carcinoma of the thyroid gland is the most common endocrine malignancy managed by the head and neck surgeon. Accepted therapy for differentiated macroscopic (greater than 1 to 1.5 cm) lesions is total or near-total thyroidectomy, followed by radioactive iodine treatment. Followup care usually consists of annual total body scan to rule out the presence of metastatic disease. Thyroglobulin, which is elaborated only by thyroid cells, either normal or metastatic, serves as a tumor marker when all functioning tissue has been ablated. The routine use of thyroglobulin assays obviates the expense and inconvenience of an annual scan. This article reviews the usefulness and limitations of serum radioimmune assays in the postoperative management of differentiated thyroid cancer. We also present several representative cases treated at our institution.
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PMID:Thyroglobulin assays in the postoperative management of differentiated thyroid cancer. 334 30

Serum thyroglobulin (Tg) radioimmunoassay and 131I whole-body scintigraphy were performed in 134 patients with previous total thyroidectomy for differentiated thyroid carcinoma. Distant spread was found in 46 patients (34%), 42 of whom had serum Tg greater than 10 micrograms/l. Accumulation of 131I in metastases was seen in 39 patients. Serum Tg in patients with iodine-accumulating metastases was significantly higher in follicular than in papillary carcinoma. Scintigraphy showed thyroid tissue remnant and no metastases in 60 patients. Serum Tg was elevated in 19 of these patients and normal in 41. The respective mean uptake of 131I in these two groups was 3.8% and 1.15% of the administered dose (p less than 0.002), indicating that ablation of normal thyroid tissue is important to avoid misinterpreting Tg findings. Scintigraphy performed after 131I in therapeutic doses of 4.5 GBq gave no information additional to that in scans after only 40 MBq 131I. The latter dose thus is adequate for depicting iodine-accumulating metastases. For diagnostic purposes, therefore, a 131I dose of 40 MBq is recommended.
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PMID:Thyroglobulin radioimmunoassay and 131I scintigraphy in patients with differentiated thyroid carcinoma. 335 95

Serum thyroglobulin (Tg) is often very elevated in patients with metastatic thyroid carcinoma and, in 18 out of 40 patients examined, serum Tg was found to exceed 400 micrograms/l. In only two of 55 patients with benign nodular thyroid disease did serum Tg exceed 400 micrograms/l. In patients presenting with metastases of unknown origin, the finding of a very elevated serum Tg concentration may therefore be of value as an indicator that the metastases are due to thyroid carcinoma. During a period in which 128 new patients with differentiated thyroid carcinoma were seen, in five who presented with metastatic disease the initial estimation of serum Tg had proved useful in suggesting the thyroid origin of the metastases.
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PMID:Serum thyroglobulin in the investigation of patients presenting with metastases. 337 Apr 17

Patients with metastases from differentiated thyroid carcinoma have a good chance of long-term survival when the diagnosis is prompt and appropriate therapy is applied early. This is also true for patients with metastases in the bone, taking into account that an appropriate therapy, usually 131-I, may be palliative in some cases. This study investigates whether serum thyroglobulin (Tg) measurement in patients with cold thyroid nodule and metastases from an unknown primary site could help identify a differentiated thyroid carcinoma. The results obtained show that Tg measurements is a useful adjunctive test when used with fine-needle aspiration biopsy. In particular, very high Tg levels point to metastatic thyroid cancer, whereas lower levels do not help determining whether metastatic cancer is of thyroid origin or not.
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PMID:High serum thyroglobulin levels. Diagnostic indicators in patients with metastases from unknown primary sites. 344 Feb 33

Two patients with poorly differentiated metastatic cancer were shown to have metastatic thyroid carcinoma. Each patient had poorly differentiated cancer and remaining thyroid tissue in the neck. The diagnosis was secured using the immunoperoxidase technique with an antibody against thyroglobulin. The proper evaluation of patients with carcinoma of unknown primary involves specific tissue identification using special techniques in pathology.
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PMID:Identification of unsuspected thyroid carcinoma using immunoperoxidase for thyroglobulin. 352 23

Serum thyroglobulin antibodies (TgAb) and serum thyroglobulin (Tg) levels were measured in 28 normal controls and 32 patients with differentiated thyroid cancer. The TgAb and Tg levels were measured in the patients when they were on replacement thyroxine therapy prior to the whole body radioiodine I-131 scan (WBS), using immunoradiometric assay kits. The TgAb level in normal controls was from 0-4.8 micrograms/ml, with a mean of 0.6 microgram/ml, while the Tg level in these controls was from 0.0-48.0 ng/ml, with a mean of 4.2 ng/ml. In the patients with thyroid cancer, the TgAb levels were normal except for a few patients who had residual thyroid or tumour in the neck and had raised levels of TgAb. Their Tg levels were normal except for 7 patients who had elevated values. 2 of these 7 had no evidence of disease on X-ray, bone scan, or WBS (I-131) while the other 5 had evidence of metastases. However, 4 patients had metastatic disease with normal Tg levels, and 2 of these patients had residual thyroid in the neck and raised TgAb levels, while in the remaining 2 patients, both Tg and TgAb were low. Serum Tg is a useful tumour marker for recurrent or metastatic thyroid cancer, but the presence of residual normal thyroid would interfere with the results.
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PMID:Serum thyroglobulin (Tg) and thyroglobulin antibodies (TgAb) in thyroid cancer. 356 73


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