Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0677930 (primary tumor)
 20,210 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study is to explore the relationship of postoperative thyroglobulin level and other clinical factors with tumor metastasis. Analysis of 281 pathologic lesions verified patients with papillary and follicular thyroid cancer who received their primary treatment at Chang Gung Memorial Hospital. Clinical information-including postoperative thyroglobulin levels, age, sex, primary tumor size, clinical staging, surgical methods, surgical findings, chest x-ray findings, and 131I uptake-were stored in the computer. Actual survival rate and univariate and multivariate analyses of these factors with the relationship of distant metastases were undertaken. Twenty-three patients in this study died of distant metastases from the thyroid cancer. Of these patients, 30.4% were older than 60 years. In contrast only 8.5% of patients in the survival group were older than 60 years (p < 0.05 in chi2). All of the papillary thyroid cancer patients with distant metastases displayed thyroglobulin levels higher than 25 ng/ml, but only 24% (41 of 173 cases) of those without distant metastases had thyroglobulin levels higher than 25 ng/ml. In 12 follicular thyroid cancer patients with distant metastases, 11 patients' serum thyroglobulin levels were higher than 25 ng/ml. In contrast, only 7 of 33 patients with follicular thyroid cancer without distant metastases displayed similar thyroglobulin levels. Univariate analysis revealed that age, postoperative thyroglobulin levels, chest x-ray findings, pathologic type, and tumor size are associated with distant metastases. One-month postoperative serum thyroglobulin level could be used as a prognostic factor for papillary and follicular thyroid cancer patients with distant metastases.
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PMID:Factors that predict metastasis of papillary and follicular thyroid cancers in Taiwan. 914 97

The TNM classification (tumor-node-metastasis) was adopted by the American Joint Committee on Cancer and the International Union against Cancer a decade ago to avoid heterogeneity of prognostic classification schemes used for differentiated thyroid cancers. To date, however, clinical data based on this classification are lacking. We retrospectively evaluate the prognosis of 700 patients (208 men and 492 women) with papillary (89%) and follicular (11%) thyroid cancers according to the pathological TNM (pTNM) staging system, treated over a 25-yr period (1970-1995). Patients who received primary treatment at our center constituted 87.4% of the cases; the majority underwent total thyroidectomy, followed by 131I ablative therapy in high risk groups, as standard treatment. Clinical and follow-up data were obtained from the medical records and our cancer registry. Disease-free and cancer-specific survival data were analyzed by Kaplan-Meier product limit estimates and Cox proportional hazard models. Patient distribution by the pTNM system were: stage I, 516 patients; stage II, 57 patients; stage III, 104 patients; and stage IV, 23 patients. Over a mean +/- SE follow-up of 11.3 +/- 0.3 yr, the overall cancer recurrence and mortality rates were 20.5% and 8.4%, respectively. However, the respective cancer recurrence and mortality rates were distinctly different in the various pTNM stages: 15.4% and 1.7% in stage I, 22% and 15.8% in stage II, 46.4% and 30% in stage III, and 66.7% and 60.9% in stage IV tumors. Using actuarial survival plots, a clear separation in both disease-free survival and cancer-specific survival was noted among all the stages (P < 0.0001). Risk factors analyses showed a significant association between all the prognostic variables used in TNM staging (age, tumor size, extent of primary tumor, and presence of nodal or distant metastases) and the observed end points of recurrence or death from thyroid cancer. After correcting for TNM stages, the risk of cancer recurrence was halved in female compared to male patients, whereas this was 1.7-fold higher in multifocal than unifocal tumors. Conversely, cancer mortality was 3.4-fold higher in follicular than papillary thyroid cancer. In the analysis of effect of primary treatment among 492 patients with tumor more advanced than the T1N0M0 category, patients who underwent less extensive surgery (lobectomy or subtotal thyroidectomy) had a 2.5-fold risk of cancer recurrence (P < 0.0001) and a 2.2-fold risk of death (P < 0.01) compared to those who underwent total or near-total thyroidectomy. Patients not treated with 131I ablation had a 2.1-fold greater risk of cancer recurrence (P < 0.0001) than those given 131I ablation, although no difference was noted in deaths from thyroid cancer. Based on our data, the pTNM classification is useful in distinguishing patients with different prognostic outcomes. However, the small patient numbers in pTNM stages other than stages I precludes us from evaluating its usefulness as a guide for therapy. Until prospective data could be accrued from controlled treatment trials, we support the standard practice of total thyroidectomy followed by 131I ablative therapy (if focal iodide uptake was noted) in patients with papillary thyroid cancer more advanced than the T1N0M0 category or of multicentric nature and in the majority of patients with follicular thyroid cancer.
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PMID:Pathological tumor-node-metastasis (pTNM) staging for papillary and follicular thyroid carcinomas: a retrospective analysis of 700 patients. 936 May 6

A total of 65 patients with radiation-induced cancers of the head and neck region were treated and evaluated. The primary disease for which the radiotherapy had been applied was benign disease in 48 patients (including tuberculous lymphadenitis in 39 patients), and malignant tumors in 17 patients (including 9 laryngeal cancers and 5 thyroid cancers). The radiation-induced cancers included 35 cases of hypopharyngeal cancer, 15 of thyroid cancer, and 13 of cervical esophageal cancer. The mean duration from radiotherapy until the diagnosis of cancer was 12.8 years in the patients with malignant primary tumor and 32.9 years in those with benign primary diseases. Most of the patients underwent surgery for their cancer. The clinical course was poor and the outcome extremely poor, especially in those patients with field carcinogenesis. It is emphasized that excessively high dosage and wide radiation field should be avoided, and that radiotherapy for young patients with malignancies requires extremely careful management.
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PMID:Radiation-induced cancers of the head and neck region. 965 14

Well-differentiated thyroid cancer (i.e. papillary microcarcinoma) may be revealed by a clinically palpable cervical node, especially in young patients. Primary tumor specificity (small-sized, superior location, invasion, multifocality) and characteristics of cervical node involvement (with synchronous central and lateral multiple node spread) require appropriate treatment by a skilled surgeon. Contrary to the primary tumor treatment (total thyroidectomy), surgical management of the cervical node basins remains controversial. Only a special knowledge of the specificity of this disease and cervical lymphatic anatomy will ensure a good prognosis for the patient.
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PMID:[Cervical lymphadenopathy revealing differentiated thyroid cancer. Review of the literature and therapeutic approach]. 988 83

Angiogenesis is important for tumor growth and progress, and the intratumor density of microvessels is a significant prognostic factor in many tumor types. The role in thyroid cancer has not been well studied, and we therefore examined a series of 128 papillary carcinomas with respect to microvessel density (MVD) and patient survival. Follow-up was obtained for all cases (median, 145 months). We found a mean MVD of 216 per mm2 (range, 35-751), and there was an average of 3.14 times more vessels in the tumors, when compared with surrounding non-neoplastic thyroid tissue. MVD was inversely related to age, tumor diameter, histological grade, and primary tumor extent. Furthermore, increasing MVD tended to be associated with improved survival (P = .056). In conclusion, our data indicate that angiogenesis is important for the development and maintenance of papillary thyroid carcinomas, although it was not identified as a prognostic factor.
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PMID:Increased angiogenesis in papillary thyroid carcinoma but lack of prognostic importance. 1082 84

Familial thyroid cancer can arise from parafollicular cells (familial medullary thyroid cancer) or from follicular cells (familial nonmedullary thyroid cancer). Familial medullary thyroid cancer may occur in isolation or as part of multiple endocrine neoplasia (MEN) type II syndromes. Genetic testing for a RET mutation on chromosome 10 is used to identify new family members who are gene carriers. Total thyroidectomy should be used in gene carriers without clinical disease before age 6 in medullary thyroid cancer and MEN type IIA, and as soon as the diagnosis is made in MEN type IIB after the first year of life. Those with clinical disease should have at least a bilateral central neck dissection. Modified radical neck dissection is recommended for patients when the primary tumor is 1.5 cm. A normal postoperative serum calcitonin level suggests that the operation has been curative. Physicians need to be aware of ethical and lifestyle issues related to patients with familial disease and their family members. Familial nonmedullary thyroid cancer occurs as a discrete entity or as part of other family cancer syndromes such as Gardner syndrome, Cowden disease, and other rare syndromes. Familial nonmedullary thyroid cancer almost exclusively includes patients with papillary or Hurthle cell cancers. These families appear to have more benign thyroid conditions. The gene (or genes) for familial papillary thyroid cancer is yet to be identified, whereas that for some Hurthle cells (TCO) has been mapped to chromosome 19p13.2. Familial nonmedullary thyroid cancer is somewhat more aggressive than its sporadic counterpart, but is less aggressive than medullary thyroid cancer. Total thyroidectomy and central neck dissection followed by radioactive iodine ablation and thyroid hormone suppression appear to be the most effective therapy.
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PMID:Familial thyroid cancer. 1114 85

Kidney metastases from thyroid cancer are rare. We report two such patients and demonstrate that the in vivo 131I uptake by the kidney metastasis is associated with high levels of sodium iodide (Na+/I-) symporter (NIS) expression in the first case. Case 1: A 61-year-old woman with papillary thyroid carcinoma-follicular variant (PTC-FV) presented with scapular metastasis. After thyroidectomy and scapulectomy, a 131I posttherapy scan showed left upper quadrant uptake. A 3.0-cm metastatic PTC-FV deposit was removed by partial nephrectomy. Case 2: A 53-year-old woman presented with back pain. A computed tomography (CT) scan showed a 3.5-cm renal mass, a multinodular goiter, and lung metastases thought secondary to a renal cell carcinoma. A unilateral nephrectomy revealed metastatic PTC-FV. After thyroidectomy, a 131I posttherapy scan showed lung and skeletal metastases. NIS immunoreactivity in tumoral tissue was strongly positive in the primary tumor, shoulder, and kidney metastasis in case 1, as well as in the primary tumor in case 2. Spotty, low-level NIS expression was observed in the kidney metastasis in case 2. In conclusion, kidney metastases of PTC-FV may occasionally retain adequate levels of NIS expression, enabling their detection during life. Thus, intense uptake in the abdomen during 131I imaging should not be assumed to be physiological gastrointestinal tract residual radionuclide activity.
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PMID:Renal metastases from thyroid papillary carcinoma: study of sodium iodide symporter expression. 1152 75

The ability of thyroid cancers to concentrate radioiodine (RAI) is dependent, in part, upon the expression and functional integrity of the sodium iodide symporter (NIS). However, some differentiated thyroid carcinomas (DTCs) and most undifferentiated thyroid carcinomas lack the ability to concentrate iodide and are thereby insensitive to 131I therapy. Variation of NIS protein expression may be an important factor in this behavior. We wished to determine whether NIS protein expression in primary DTC tumors correlated with the subsequent RAI uptake by metastatic lesions in the same patients. We obtained paraffin-embedded tissue specimens from 60 patients with metastatic thyroid cancer who had undergone total or near-total thyroidectomy at the Mayo Clinic for DTC and had known presence or absence of RAI uptake in their tumor deposits determined by total body scanning after thyroid hormone withdrawal. Tissue sections from the primary intrathyroidal tumors were subjected to immunostaining (IS) using a monoclonal antibody against human NIS. Slides were subsequently examined for specific IS by two independent reviewers. For each patient, whole body scan (WBS) uptake was recorded, and correlation between results of IS and WBS was analyzed. Of 43 patients with a positive WBS, 37 also had positive IS of their tumors. In six patients with negative IS, a positive WBS was documented, and in three of these cases TSH at the time of surgery was less than 0.3 mIU/liter. Of the 17 patients with negative WBS, 10 were also negative on IS. Positive IS accurately predicted a positive scan in our study in 84% of cases; the ability of the IS to detect all cases with a positive scan was 86%, and it increased to 90% when patients who were receiving thyroid hormone therapy at the time of surgery were excluded from the analysis. Overall, the results of our retrospective study suggest that NIS IS of the thyroidal primary tumor in patients with papillary and follicular thyroid cancers has substantial ability to predict the behavior of subsequent deposits of metastatic and recurrent cancer with respect to iodine trapping and concentration. Our findings require confirmation in prospective studies to more accurately determine the predictive ability of the test and its role in the postoperative management of patients with DTC. If confirmed, NIS IS of DTC primary lesions may prove useful in the management of patients with known or suspected metastatic thyroid cancer.
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PMID:Immunohistochemical analysis of sodium iodide symporter expression in metastatic differentiated thyroid cancer: correlation with radioiodine uptake. 1170 45

The basic biological principle for 131I treatment of patients with thyroid cancer is the ability of well-differentiated tumor cells to uptake iodine. The absorption of adequate activities of radioiodine may sterilize primary tumor cells and the metastatic deposits. The basic factors which determine the effectiveness of radioiodine treatment include the effective half-life of 131I, the discrete energy of its beta decay, the effective range of emitted beta-rays, the activity of individual therapeutic doses, the intrinsic ability of tumor to uptake radioiodine, and the absorbed total radiation dose. The biological factors, which contribute to the effectiveness of radioiodine treatment, can be referred to "five Rs" of radiobiology: radiosensitivity, repair, redistribution, reoxygenation, and repopulation. The theoretical radiobiological considerations suggest that improvements in therapeutic indexes of radioiodine treatment are possible, e.g. by unconventional fractionation of 131I, or by combining the radionuclide therapy with external-beam irradiation. The net effect of such strategies in the clinic is, however, often unpredictable, and remains investigational and controversial. This illustrates the need for improved design of new research in clinical and experimental radiobiology of radioiodine treatment.
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PMID:[Radiobiologic basis for using 131I to treat patients with thyroid cancer]. 1218 35

We report the case of a 68-year-old patient with a known paravertebral malignant schwannoma, sent to us for postoperative staging. A combined whole-body PET/CT scan showed only poor (18)F-fluorodeoxyglucose uptake in the region of the primary tumor but distinct increased fluorodeoxyglucose uptake in the left and right thyroid gland. Thyroid sonography showed two hypoechogenic nodules. Ultrasound-guided fine-needle aspiration biopsy of one nodule showed oxyphil transformed cells, compatible with malignancy. Based on these findings, the patient underwent a subtotal thyroidectomy. Histopathology of the specimen revealed a chronic follicular Hashimoto's thyroiditis. This case demonstrates that Hashimoto's thyroiditis can mimic thyroid cancer in PET but also in sonography and fine-needle aspiration biopsy.
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PMID:Increased 18F-FDG uptake mimicking thyroid cancer in a patient with Hashimoto's thyroiditis. 1292 62


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