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THYROID
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A clinicopathologic study of minimally
invasive follicular carcinoma of the thyroid gland with a review of
the English literature.
Thompson LD, Wieneke JA, Paal E, Frommelt RA, Adair CF, Heffess CS.
Cancer. 2001 Feb 1;91(3):505-24.
BACKGROUND: The criteria for minimally invasive (low grade)
follicular carcinoma of the thyroid (MI) remain controversial, often
resulting in unnecessary treatment.
METHODS: The records of 130 patients with minimally invasive (MI)
follicular thyroid carcinoma were retrieved from the files of the
Endocrine Tumor Registry of the Armed Forces Institute of Pathology.
RESULTS: Ninety-five patients were confirmed to have MI based on the
authors' criteria of small-to-medium vessel invasion, capsular
invasion of up to full thickness, no parenchymal tumor extension,
and no tumor necrosis (patients with oxyphilic tumors were
excluded). The remaining 35 patients had tumors that were
reclassified as "not low grade" based on large vessel invasion,
extension into parenchyma, and tumor necrosis (oxyphilic cases
excluded). The MI patients included 67 women and 28 men, ages 20-95
years (average, 42.0 years). Nearly all patients presented with a
thyroid mass (n = 90 patients). The mean tumor size was 2.8 cm.
Histologic features examined for tumor classification included
cellularity, capsule nature, capsular invasion, vascular invasion,
extension into parenchyma, cytoplasmic oxyphilia, mitotic activity,
and necrosis. All patients were treated with surgical excision.
Adjuvant radioactive iodine therapy was performed in 24 patients.
Five patients developed recurrent disease: four were alive or had
died without evidence of disease after additional treatment (mean,
18.1 years), and one patient died with disease (MI tumor) at 15.1
years. All of the remaining patients were disease free (mean
follow-up, 16.5 years).
CONCLUSIONS: There are reproducible histologic criteria to diagnose
patients with MI follicular carcinoma. The overall excellent long
term prognosis and a good patient outcome suggests that no
additional surgery is necessary. Copyright 2001 American Cancer
Society.
PMID: 11169933
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Malignant lymphoma of the thyroid gland:
a clinicopathologic study of 108 cases.
Derringer GA, Thompson LD, Frommelt RA, Bijwaard KE, Heffess CS,
Abbondanzo SL.
Am J Surg Pathol. 2000 May;24(5):623-39.
We report a retrospective clinicopathologic study of 108 primary
thyroid gland lymphomas (PTLs), classified using the REAL and
proposed WHO classification schemes. The patients included 79 women
and 29 men, with an average age of 64.3 years. All patients
presented with a thyroid mass. The PTLs were classified as marginal
zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) or
MZBL (n = 30), diffuse large B-cell lymphoma (DLBCL) with MZBL (n =
36), DLBCL without MZBL (n = 41), and follicle center lymphoma (FCL;
n = 1). Excluding the FCL, features of lymphomas of MALT-type were
identified in all groups, despite a follicular architecture in 23%
of cases. Lymphocytic thyroiditis (LT) was identified in 94%.
Ninety-one percent of patients presented with stage IE or IIE
disease, whereas 69% had perithyroidal soft tissue infiltration. All
patients were treated with surgical excision followed by adjuvant
therapy (76%): chemotherapy (15%), radiation (19%), or a combination
of radiation and chemotherapy (42%). Disease-specific survival was
82% at last follow up (mean, 82.8 mos) and 79% at 5 years.
Statistically, stages greater than IE, presence of DLBCL, rapid
clinical growth, abundant apoptosis, presence of vascular invasion,
high mitotic rate, and infiltration of the perithyroidal soft tissue
were significantly associated with death with disease. No patients
with MZBL or stage IE disease died with disease. In summary, PTLs
typically occur in middle- to older-aged individuals as a thyroid
mass, with a predilection for females. Despite their histologic
heterogeneity and frequent simulation of other lymphoma subtypes,
virtually all PTLs are lymphomas of MALT-type arising in the setting
of LT. Mixed DLBCL and MZBL are common. Overall, PTLs have a
favorable outcome with appropriate therapy, but prognosis depends on
both clinical stage and histology. MZBL and stage IE tumors have an
excellent prognosis, whereas tumors with a large cell component or
DLBCL or stage greater than IE have the greatest potential for a
poor outcome.
PMID: 10800981
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Primary thyroid teratomas: a
clinicopathologic study of 30 cases.
Thompson LD, Rosai J, Heffess CS.
Cancer. 2000 Mar 1;88(5):1149-58.
BACKGROUND: Primary thyroid teratomas are rare thyroid gland
neoplasms of germ cell derivation that display features of
trilineage differentiation.
METHODS: The histologic and immunophenotypic features of 30 cases of
thyroid teratomas were reviewed, patient follow-up was obtained, and
the results were analyzed statistically.
RESULTS: The patients included 15 females and 15 males ages
newborn-56 years (mean, 12.4 years). All patients presented
clinically with a mass in the thyroid, ranging in size from 2.0-13
cm in greatest dimension (mean, 6.0 cm). Histologically, the tumors
usually were well circumscribed, although occasionally infiltrative
into the thyroid parenchyma. Derivatives of all three germ layers
(ectoderm, mesoderm, and endoderm) were present in varying degrees
of maturity. The tumors were divided into benign (n = 7 tumors),
immature (n = 14 tumors), and malignant (n = 9 tumors) as determined
by an increasing percentage of tumor volume comprised of primitive
mesenchymal or neural-type tissue. All the microscopically malignant
tumors occurred in the adult population. Surgical excision was
performed in 28 patients, followed by adjuvant therapy in 5
patients. Follow-up was obtained in 26 patients; 8 patients had died
from or with tumor (5 neonates with immature histology and 3 adults
with malignant histology; mean, 0.6 years) and 18 patients were
alive with no evidence of disease at a mean of 16.9 years of
follow-up.
CONCLUSIONS: Thyroid teratomas are rare neoplasms that can be
divided into three types depending on the presence and proportion of
the immature component. The outcome is dependent largely on the age
of the patient, the size of the tumor at the time of initial
presentation, and the presence and proportion of immaturity.
Surgical excision is the treatment of choice, with adjuvant therapy
reserved for the malignant cases. Copyright 2000 American Cancer
Society.
PMID: 10699906
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A rationale for conservative management
of microscopic papillary carcinoma of the thyroid gland: a
clinicopathologic correlation of 90 cases.
Rassael H, Thompson LD, Heffess CS.
Eur Arch Otorhinolaryngol. 1998;255(9):462-7.
Microscopic papillary carcinoma of the thyroid gland (MPC) measuring
< or = 1.0 cm in diameter has a generally benign outcome, but is
often overtreated with additional surgery. Ninety cases of MPC and
77 cases of nonmicroscopic papillary carcinoma of the thyroid gland
(non-MPC) from 1970 to 1980 were retrieved from the Endocrine
Registry of the Armed Forces Institute of Pathology (AFIP),
Washington, D.C. Histologic features and patient follow-up were
analyzed. Twenty-one patients with MPC had multifocal disease within
the affected thyroid lobe, while a further 15 had either bilateral
or intraglandular spread. Four of 10 patients who had additional
surgery were found to have additional foci of tumor. Fourteen
patients with lymph node metastases at initial surgery had no
subsequent nodal metastases. All patients were either alive without
disease or had died of unrelated causes after an average follow-up
period of 17.3 years. Of the 77 non-MPC patients, 13 developed lymph
node metastases or local recurrences, and one died of metastatic
disease. Sixty-four of these patients were alive without evidence of
disease after an average follow-up of 22 years. Present findings
show that while MPC may present with perithyroidal lymph node
metastases (15.56%), patients do not develop clinical tumors in the
remaining thyroid tissue. Our experience indicates that close
clinical follow-up without additional surgery is the preferable
management for patients with MPC.
PMID: 9833215
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Thyroid papillary carcinoma of columnar
cell type: a clinicopathologic study of 16 cases.
Wenig BM, Thompson LD, Adair CF, Shmookler B, Heffess CS.
Cancer. 1998 Feb 15;82(4):740-53. -- Comment in: Cancer. 1998
Dec 1;83(11):2421-3.
BACKGROUND: Thyroid papillary carcinoma of columnar cell type is
considered an uncommon histologic subtype of papillary carcinoma
characterized by its morphologic features and purportedly aggressive
biologic course.
METHODS: Sixteen cases of thyroid papillary carcinoma of columnar
cell type were identified from the Endocrine Tumor Registry at the
Armed Forces Institute of Pathology and the Washington Hospital
Center. Clinical records and follow-up were available in all cases.
Paraffin blocks were available for histochemical and
immunohistochemical studies in 15 of the 16 cases.
RESULTS: Of the 16 cases reported, 13 patients were female and 3
were male. The ages ranged from 16-76 years (average, 47 years;
median, 40 years). An asymptomatic neck mass was the most common
clinical presenting symptom. Macroscopically, the tumors varied from
circumscribed or encapsulated to infiltrative, ranging in size from
1.5-6.5 cm. Histologically, the tumors had diverse growth patterns,
including papillary, solid, microfollicular, and cribriform. A
common pattern was the presence of markedly elongated follicles
arranged in parallel cords. Colloid-filled follicles could be found,
at least focally, in all cases. The characteristic histologic
appearance included the presence of elongated cells showing nuclear
stratification. Other features included the presence of
vacuolated-appearing cells, spindle-shaped cells, and squamoid
nests. Limited areas in the tumors showed morphologic features
typical of thyroid papillary carcinoma. In 14 of the cases, the
tumor was encapsulated, showed limited invasive growth, or was a
microscopic tumor. In two of the cases, there was extrathyroidal
invasion. Immunohistochemical studies showed consistent reactivity
with cytokeratin and vimentin; varied reactivity with thyroglobulin,
epithelial membrane antigen, carcinoembryonic antigen, and LeuM1;
and no reactivity with calcitonin or chromogranin. Treatment was by
surgical resection; supplemental radioactive iodine therapy was
administered in eight patients. Follow-up was available for all
patients, 13 of whom (81%) were alive and free of disease or had
died of unrelated causes over periods ranging from 2-11 years
(average, 5.8 years). All 13 of these patients had tumor confined
completely to the thyroid gland. One patient died 4 months after
diagnosis secondary to sepsis. Two patients (17%) had aggressive
biologic courses. In both patients there was extrathyroidal
invasion. One of these patients died of metastatic disease to the
lungs 3 years after diagnosis; the other was alive with bilateral
pulmonary metastases 9 years after the diagnosis.
CONCLUSIONS: The findings of the current study indicate that thyroid
papillary carcinoma of columnar cell type is a distinct morphologic
type but not a distinct clinical type of thyroid papillary
carcinoma. The biologic behavior of this tumor is predicated on
clinical stage, with the presence or absence of extrathyroidal
invasion being the single most important parameter. Treatment of
patients with these tumors should be based on the clinical stage and
not on the morphologic appearance.
PMID: 9477108
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Metastatic renal cell carcinoma to the
thyroid gland: a clinicopathologic study of 36 cases.
Heffess CS, Wenig BM, Thompson LD.
Cancer. 2002 Nov 1;95(9):1869-78.
BACKGROUND: Clear cell tumors of the thyroid gland in general are
uncommon. Metastatic renal cell carcinoma (RCC) to the thyroid gland
is a rare occurrence but must be considered in the differential
diagnosis of a thyroid gland clear cell neoplasm to prevent
misclassification, potentially resulting in inappropriate clinical
management.
METHODS: Thirty-six cases of metastatic RCC to the thyroid were
retrospectively retrieved from the files of the Endocrine Registry
of the Armed Forces Institute of Pathology.
RESULTS: The tumors occurred in 22 women and 14 men, ages 53-80
years (mean, 64.9 years). Symptoms were present for a mean of 13.0
months. The tumors generally affected a single lobe of the thyroid
gland as a solitary mass (n = 30; 83%), measuring 1.0-15.0 cm in
diameter (mean, 3.8 cm). Histologically, the tumors were composed of
polygonal cells with clear cytoplasm, distinct cell membranes, and
small compact eccentric nuclei within a rich vascular network.
Diastase-sensitive, periodic acid-Schiff-positive material (n = 22;
61%) and/or Oil Red O-positive material (n = 5; 14%) were noted.
Thyroglobulin immunohistochemistry was negative in the foci of
metastatic RCC. Although the majority of the patients had documented
previous evidence of an RCC (n = 23; 64%) as remotely as 21.8 years
before the thyroid metastases (mean, 9.4 years), the metastatic
tumor to the thyroid gland was the initial manifestation of RCC in
13 patients. The majority of patients (n = 23; 64%) died with
disseminated disease (mean, 4.9 years), but 13 patients (36%) were
alive or had died without evidence of disease (mean, 9.1 years).
CONCLUSIONS: In the presence of a clear cell tumor of the thyroid
gland, the diagnostic considerations must include metastatic RCC.
The light microscopic features may suggest this possibility and the
diagnosis can be established by supplemental histochemical and
immunohistochemical studies. Surgical treatment of the metastatic
disease is suggested, as this may result in prolonged patient
survival. Published 2002 by the American Cancer Society.
PMID: 12404280
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Diffuse sclerosing variant of papillary
thyroid carcinoma: a clinicopathologic and immunophenotypic analysis
of 22 cases.
Thompson LD, Wieneke JA, Heffess CS.
Endocr Pathol. 2005 Winter;16(4):331-48.
BACKGROUND: The diffuse sclerosing variant of papillary thyroid
carcinoma (DSV-PTC) is an uncommon tumor making up about 2% of all
papillary thyroid carcinomas. Previous studies have not
comprehensively evaluated these tumors in a large series of
patients.
DESIGN: Twenty-two cases of DSV-PTC diagnosed between 1970 and 2000
were identified in the files of the AFIP. Histologic and
immunohistochemical features were evaluated and patient follow-up
was obtained.
RESULTS: The tumors affected 14 females and 8 males, aged 6 to 49 yr
(mean, 18 yr), with males presenting at a mean older age than
females (24 vs 14 yr). Symptoms included an enlarging mass in the
thyroid, present for a mean of 9.5 mo. While a dominant tumor was
identified in a single lobe, bilateral disease was common (n = 16).
The dominant mass ranged in size from 1.7 to 5.8 cm in diameter
(mean, 3.8 cm). Histologically, all cases demonstrated a papillary
carcinoma (conventional, solid, or follicular pattern) diffusely
involving the gland. Extrathyroidal extension, lymphocytic
thyroiditis, squamous metaplasia, increased fibrosis/sclerosis, and
psammoma bodies were present to a variable degree. Both the
papillary carcinoma and squamous metaplasia cells were strongly
immunoreactive with CK19, thyroglobulin, and TTF-1. An increased
number of S-100 protein immunoreactive dendritic cells were
recognized. p53 was increased (>15%) in the tumor cells in 12
patients, while Ki-67 was increased in the tumor cells in two
patients. Perithyroidal and cervical lymph node metastasis occurred
in 18 (82%) patients. All metastases demonstrated histologic
features similar to the primary. Complete resection (thyroidectomy
in 18 patients) with lymph node dissection, yielded a 95% 5-yr
survival without evidence of disease. One patient died of disease
after a malignant transformation of the squamous metaplasia into
squamous cell carcinoma.
CONCLUSIONS: The recognition of DSV-PTC can be made with the
following features: classic to solid foci of PTC, lymphocytic
thyroiditis, squamous metaplasia, increased fibrosis, and
innumerable psammoma bodies. DSV-PTC is more biologically aggressive
than conventional PTC, but the patients' survival is not
significantly different. This diagnosis should lead the clinician to
aggressively manage these patients (thyroidectomy and lymph node
dissection) in an effort to achieve an excellent long-term clinical
outcome.
PMID: 16627920
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Peripheral Nerve Sheath Tumors of the
Thyroid Gland: A Series of Four Cases and a Review of the
Literature.
Thompson LD, Wenig BM, Adair CF, Heffess CS.
Endocr Pathol. 1996 Winter;7(4):309-318.
Primary peripheral nerve sheath tumors (PNSTs) of the thyroid gland
are exceptionally rare. Two schwannomas and two malignant PNSTs
(MPNSTs), arising primarily within the thyroid gland, were
identified in the files of the Endocrine Tumor Registry at the Armed
Forces Institute of Pathology. The patients included two females,
age 69 and 80 yr, and two males, age 18 and 33 yr. The patients
presented with a mass in the thyroid gland confined to a single lobe
of the thyroid without involvement of the cervical neck region. None
of the patients had a history of neurofibromatosis. The benign
tumors were encapsulated, one of them cystic, with the
characteristic cellular and nuclear features of schwannomas. The
MPNSTs were invasive tumors, effacing the thyroid parenchyma, with a
fascicular pattern of growth composed of neural appearing cells with
increased cellularity, increased mitotic activity, and with focal
necrosis. Immunoreactivity for 5100 protein and vimentin was seen in
all tumors. The patients with schwannomas, treated only by surgical
resection, were alive without evidence of disease, over a period of
5-33 yr. Both patients with MPNSTs died of the disease 8 mo and 42
mo, respectively, with widely disseminated disease. Primary thyroid
PNSTs are exceptionally rare tumors. MPNSTs, in this limited
experience, have a fatal outcome irrespective of aggressive adjuvant
therapy.
PMID: 12114802
Hyalinizing trabecular adenoma of the
thyroid gland.
Thompson LD.
Ear Nose Throat J. 2011 Sep;90(9):416-7.
FIRST PARAGRAPH: Hyalinizing trabecular ade-noma (HTA) is a very rare tumor (<1% of all primary thyroid gland tumors) of thyroid follicular cell origin with a trabecular pattern of growth and marked intratrabecular hyalinization. For all intents and purposes, this is a benign tumor, although there is a case report of pulmonary metastasis with invasion, suggesting the term tumor be used instead of adenoma. A few cases have occurred following radiation exposure, and there may be a relationship to thyroid papillary carcinoma, as there have been reports of RET/PTC rearrangements.
PMID: 21938699
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Medullary thyroid carcinoma.
Thompson LD.
Ear Nose Throat J. 2010 Jul;89(7):301-2.
FIRST PARAGRAPH: Medullary thyroid carcinoma (MTC) is a malignant
epithelial tumor of the thyroid gland that exhibits C-cell
differentiation. C cells arise from the ultimobranchial body, which
is derived from the fourth pharyngeal pouch, and they are found in
the upper and middle areas of the thyroid lobes. These cells produce
calcitonin, a hormone involved in calcium homeostasis. While a
number (20%) of MTCs are associated with the autosomal-dominant
inherited multiple endocrine neoplasia (MEN) syndromes (specifically
MEN2A and MEN2B), most (80%) cases are sporadic. Germline or somatic
mutations of the RET gene are characteristic of this tumor. They
usually involve an activating point mutation of 10q11.2.
Specifically, codon 634 in exon 11 is most common in MEN2A, while
codon 918 in exon 16 is most common in MEN2B.
PMID: 20628986
See full article (<1 MB .pdf)
Primary smooth muscle tumors of the
thyroid gland.
Thompson LD, Wenig BM, Adair CF, Shmookler BM, Heffess CS.
Cancer. 1997 Feb 1;79(3):579-87.
BACKGROUND: Primary smooth muscle tumors of the thyroid gland are
rare. To date, there are few cases reported of primary thyroid
leiomyomas and leiomyosarcomas.
METHODS: One leiomyoma and four leiomyosarcomas arising within the
thyroid gland were identified in the files of the Endocrine Tumor
Registry of the Armed Forces Institute of Pathology. Histologic and
immunohistochemical features were reviewed and follow-up obtained.
RESULTS: The patients included 2 females, ages 56 and 64 years, and
3 males, ages 45, 68, and 83 years. The patients presented with a
mass in the thyroid gland that had increased in size over a number
of months. All the tumors originated within a single lobe of the
thyroid gland and measured from 1.1 to 9 cm in greatest dimension.
Histologically, there was a fascicular pattern of growth comprised
of spindle-shaped cells with blunt-ended nuclei. The leiomyoma was
encapsulated, cytologically bland, and amitotic; the leiomyosarcomas
were invasive with increased cellularity, pleomorphism, a high
mitotic rate, necrosis, and hemorrhage. Immunohistochemical staining
showed reactivity with vimentin, smooth muscle actin, muscle
specific actin, and desmin. The patient with the leiomyoma was alive
without evidence of disease 11 years after the initial presentation,
with surgical resection as the only treatment. Three of the patients
with leiomyosarcomas were dead within 2 years of diagnosis, in spite
of aggressive therapeutic intervention. The remaining patient was
still alive 10 months after initial presentation with multiple lung
metastases.
CONCLUSIONS: Smooth muscle tumors of the thyroid gland are
distinctive tumors. Leiomyosarcomas can be distinguished from
anaplastic carcinoma, although patient outcome is uniformly
unfavorable.
PMID: 9028371
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Langerhans cell histiocytosis of the
thyroid: a series of seven cases and a review of the literature.
Thompson LD, Wenig BM, Adair CF, Smith BC, Heffess CS.
Mod Pathol. 1996 Feb;9(2):145-9.
Langerhans cell histiocytosis is a rare disorder, with a few reports
describing isolated thyroid gland involvement. We report seven
cases, which included four females and three males ranging in age
from 2 months to 55 years, with a median age of 37 years.
Histologically, the cases demonstrated either diffuse or focal
involvement of the thyroid gland by Langerhans cell histiocytes,
characterized by bean-shaped, lobated, folded nuclei. In association
with the histiocytic infiltrate, there was a prominent eosinophilic
cellular component, as well as destruction of the thyroid follicles.
All cases occurred in a background of lymphocytic thyroiditis. One
case demonstrated adenomatoid nodules, whereas another had a
microscopic papillary carcinoma. Immunohistochemical staining
demonstrated positive reactivity with S-100 protein, lysozyme, and
KP-1. Four patients with isolated thyroid disease, treated by
surgical resection alone, are alive without systemic disease from 3
to 19 years after initial presentation. The three patients with
systemic disease died within 1 year of the initial diagnosis with
disease-related complications. Localized disease portends a
favorable prognosis as compared to the thyroid involvement as part
of systemic disease.
PMID: 8657721
Langerhans cell histiocytosis isolated to
the thyroid gland.
Thompson LD.
Eur Arch Otorhinolaryngol. 1996;253(1-2):62-5.
Isolated Langerhans cell histiocytosis of the thyroid is an
extremely rare occurrence, with only one case previously reported. A
case of Langerhans cell histiocytosis isolated to the thyroid gland
associated with lymphocytic thyroiditis is presented and clinical
implications are discussed.
PMID: 8932433
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Intratracheal ectopic thyroid tissue: a
case report and literature review.
Byrd MC, Thompson LD, Wieneke JA.
Ear Nose Throat J. 2003 Jul;82(7):514-8.
We discuss a case of intratracheal ectopic thyroid tissue (ETT) that
was retrieved from the files of the Otorhinolaryngic--Head and Neck
Pathology Registry at the Armed Forces Institute of Pathology. The
patient was a 54-year-old man who had a history of papillary thyroid
carcinoma, which had been treated with a subtotal thyroidectomy.
During routine follow-up 4 years later, the patient's primary care
physician detected an elevated thyroglobulin level. Further
referrals and evaluations revealed that the patient had
intratracheal ETT. The patient refused to undergo surgical excision
and remains without evidence of recurrent carcinoma. In a MEDLINE
literature review, we found only 13 other well-documented cases of
intratracheal ETT since 1966; in all but two cases, patients had
benign disease. Once the possibility of thyroid carcinoma has been
eliminated by histologic examination, intratracheal ETT can be
managed by complete surgical excision with the prospect of an
excellent long-term clinical outcome.
PMID: 12955837
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Papillary thyroid carcinoma.
Nelson BL, Thompson LD.
Ear Nose Throat J. 2004 Oct;83(10):675-6.
FIRST PARAGRAPH: Papillary thyroid carcinoma is the most common type
of thyroid malignancy. The tumor occurs largely in adults, usually
those between the ages of 20 and 50 years; the female-to-male ratio
is 4:1. Papillary thyroid carcinoma is also the most common
pediatric thyroid malignancy.
PMID: 15586863
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Endoscopic management of intratracheal
ectopic thyroid.
Pritchyk KM, Thompson LD, Malekzadeh S.
Otolaryngol Head Neck Surg. 2004 May;130(5):630-2.
PMID: 15138431
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Subacute (de Quervain's) thyroiditis.
Thompson LD, Heffess CS.
Ear Nose Throat J. 2002 Sep;81(9):623.
FIRST PARAGRAPH: Subacute (de Quervain's) thyroiditis is a seasonal
disorder that generally affects middle-aged women. It is
characterized by neck pain and generalized malaise, fatigue, fever,
and chills following an upper respiratory infection, usually of
viral etiology. Thyroid gland palpation elicits exquisite tenderness
of the firm gland, which can be involved either focally or
diffusely. The stage the disease determines whether there is hyper-
or hypothyroidism.
PMID: 12353438
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Minimally invasive follicular thyroid
carcinoma.
Heffess CS, Thompson LD.
Endocr Pathol. 2001 Winter;12(4):417-22.
Infiltration of the capsule, vascular invasion, and/or neoplastic
extension into the adjacent parenchyma are regarded as prerequisites
for the diagnosis of follicular carcinoma. In modern practice, most
of these tumors fall into the category of follicular carcinoma,
minimally invasive (FCMI) characterized by evidence of limited
capsular or vascular invasion with an excellent long-term prognosis
and a good patient outcome. Notwithstanding the wide acceptance of
the diagnostic criteria established by the World Health Organization
for the classification of follicular carcinomas in particular, they
have been difficult to apply and have led to a great deal of
confusion. This confusion is compounded when applied to "low-grade"
or "minimally invasive" follicular carcinoma because of the poor
reproducibility of the classification and the variable results
reported in the literature. Our surgical colleagues face a similar
lack of a standardized treatment for low-grade follicular
carcinomas, which leads to unnecessary surgical treatment.
Standardization of histologic criteria is necessary to promote
confidence and uniformity in the therapeutic approach of these
tumors. We believe that a FCMI is defined as an encapsulated
follicular tumor (not papillary), with only small to medium vessel
invasion within or immediately adjacent to the tumor capsule and/or
up to full-thickness capsular transgression without accompanying
extension into the thyroid parenchyma with intervening fibrosis. By
using these criteria, patients can be managed with conservative
surgical excision to yield an excellent long-term patient outcome.
PMID: 11914475
See full article (1 MB .pdf)
Intratracheal ectopic thyroid tissue: a
case report and literature review.
Byrd MC, Thompson LDR, Wieneke JA
Ear Nose Throat J 2003;82:514-518
We discuss a case of intratracheal ectopic thyroid tissue (ETT) that
was retrieved from the files of the Otorhinolaryngic--Head and Neck
Pathology Registry at the Armed Forces Institute of Pathology. The
patient was a 54-year-old man who had a history of papillary thyroid
carcinoma, which had been treated with a subtotal thyroidectomy.
During routine follow-up 4 years later, the patient's primary care
physician detected an elevated thyroglobulin level. Further
referrals and evaluations revealed that the patient had
intratracheal ETT. The patient refused to undergo surgical excision
and remains without evidence of recurrent carcinoma. In a MEDLINE
literature review, we found only 13 other well-documented cases of
intratracheal ETT since 1966; in all but two cases, patients had
benign disease. Once the possibility of thyroid carcinoma has been
eliminated by histologic examination, intratracheal ETT can be
managed by complete surgical excision with the prospect of an
excellent long-term clinical outcome.
PMID: 12955837
Neoplasms metastatic to the thyroid
gland.
Thompson L.
Ear Nose Throat J. 2006 Aug;85(8):480, 483.
FIRST PARAGRAPH: Tumors that occur in the thyroid gland as a result
of lymph or vascular spread from distant sites are considered to
represent metastatic disease rather than a direct extension of a
primary from an adjacent organ. Metastatic deposits are identified
at a higher frequency in abnormal glands—that is, those with
adenomatoid nodules, thyroiditis, and follicular neoplasms. Further,
metastatic deposits may be found within primary thyroid tumors, such
as a renal cell carcinoma metastatic to a thyroid papillary
carcinoma. Although a thyroid gland mass may be the presenting
clinical sign, it is more often the underlying thyroid gland disease
(e.g., thyroiditis, adenomatoid nodules) that prompts clinical
evaluation. The thyroid gland metastatic deposit is the initial
presentation of an occult primary tumor in as many as 40% of
patients. Carcinomas are the most common metastatic tumors from (in
order of frequency) the kidney (figure 1), lung, breast (figure 2),
and stomach; melanoma is less common.
PMID: 16999049
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Dyshormonogenetic goiter of the thyroid
gland.
Thompson L.
Ear Nose Throat J. 2005 Apr;84(4):200.
FIRST PARAGRAPH: Dyshormonogenetic goiter is the name given to a
family of inborn errors of metabolism that lead to defects in the
synthesis of thyroid hormone. The prevalence of this disease is 1 in
30,000 to 50,000 live births, and it is the second most common cause
(10 to 15%) of permanent congenital hypothyroidism.
PMID: 15929313
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College of
American Pathologists (CAP)
Protocol for the Examination of Specimens from Patients with
Carcinoma of the Thyroid Gland
Protocol applies to all carcinomas of the thyroid gland. Lymphomas,
sarcomas and metastases are not included.
Based on AJCC/UICC TNM, 7th edition
Protocol web posting date: October 2009
Protocol effective date: January 2010
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