bromochloroacetic-acid and Carcinoma--Papillary--Follicular

The precise diagnosis of follicular thyroid lesions is frequently debated because of the subjective nature of capsular invasion as well as both the histological and cytological characteristics. Furthermore, several different prognostic indices have been devised to examine prognosis associated with thyroid cancer. Herein, we describe how these confounding elements can affect the ability to accurately predict prognosis for patients with follicular thyroid lesions.

Topics: Adenocarcinoma, Follicular; Adenoma; Biomarkers, Tumor; Carcinoma, Papillary; Carcinoma, Papillary, Follicular; Diagnosis, Differential; Galectin 3; Humans; Keratins; Lymphatic Metastasis; Neoplasm Invasiveness; Prognosis; Thyroid Neoplasms

Tumor-to-tumor metastasis in thyroid neoplasms is exceedingly uncommon. Two unusual cases of breast carcinoma and renal cell carcinoma metastatic to follicular variant papillary carcinoma are reported. On histologic sections, the donor tumor cells infiltrated the substance of the recipient tumor and the angiolymphatic channels, but the bulk of metastatic tumor was confined within the thyroid carcinoma. Immunohistochemical stains as well as molecular studies confirmed the origin of both donor tumors, as well as the diagnosis of follicular variant of papillary carcinoma in the recipient tumors. Distinguishing between two such tumor populations may be difficult when the donor tumor cells morphologically resemble primary neoplasms of the recipient organ. A history of previous malignancy and ancillary studies can be helpful in making this distinction and rendering the correct diagnosis. A brief review of literature and discussion of tumor-to-tumor metastasis in thyroid neoplasms is also presented.

Topics: Apoptosis Regulatory Proteins; Biomarkers; Biomarkers, Tumor; Breast Neoplasms; Carcinoma, Lobular; Carcinoma, Papillary, Follicular; Carcinoma, Renal Cell; DNA-Binding Proteins; Female; Galectin 3; Humans; Immunohistochemistry; Keratins; Kidney Neoplasms; Loss of Heterozygosity; Male; Microsatellite Repeats; Middle Aged; Neoplasm Metastasis; Neoplasms, Second Primary; Neprilysin; Nuclear Proteins; Thyroglobulin; Thyroid Neoplasms; Trans-Activators; Transcription Factors; Vimentin

To study Twist expression in thyroid papillary carcinoma (PTC) by immunohistochemistry and to assess its usefulness as marker in the differential diagnosis of PTC, follicular adenomas (FA) and benign papillary lesions (BPL).. Fifty cases of PTC, 48 cases of FA and 47 cases of BPL were evaluated using manual tissue chip and SP immunohistochemical stain to detect the expression of Twist and HBME-1, and comparing the staining to that of cytokeratin 19 (CK19).. In PTC, positive rates of Twist, HBME-1 and CK19 were 100% (48/48), 94.0% (47/50) and 78.0% (39/ 50) respectively; in FA, positive rates were 0, 6.7% (3/45) and 0 respectively; in BPL, positive rates were 7.0% (3/34), 2.1% (1/47) and 0, respectively. The differences between PTC and FA and between PTC and BPL were both statistically significant (P = 0. 000). The sensitivity of Twist, HBME-1 and CK19 was 100%, 94.0% and 78.0%; the specifity was 96.4%, 95.7% and 100%; overall accurary was 97.7%, 95.1% and 91.9%, respectively.. Positive rates of Twist is higher than the other markers in PTC. Immunohistochemical staining of Twist has important significance in the differential diagnosis of thyroid lesions. Twist immunohistochemistry maybe helpful in diagnosis and differential diagnosis of PTC.

Topics: Adenocarcinoma, Follicular; Adenocarcinoma, Papillary; Adenoma; Biomarkers, Tumor; Carcinoma, Papillary; Carcinoma, Papillary, Follicular; Diagnosis, Differential; Galectin 3; Immunohistochemistry; Keratin-19; Keratins; Nuclear Proteins; Thyroid Neoplasms; Thyroid Nodule; Twist-Related Protein 1

The distinction between benign and malignant thyroid tumors is critical for the management of patients with thyroid nodules. We applied immunohistochemical staining for galectin-3, HBME-1, cytokeratin 19 (CK19), high molecular weight cytokeratin (HMWCK), cyclin D1 and p27(kip1) in 295 thyroid lesions to determine their diagnostic accuracy. The expression of all markers was significantly associated with differentiated thyroid carcinoma (DTC). The sensitivity for the diagnosis of DTC was 94.7% with galectin-3, 91.3% with HBME-1, and 90.3% with CK19. The specificities of these markers were 95.5%, 69.7%, and 83.1%, respectively. Combining these markers, co-expression of galectin-3 and CK19 or galectin-3 and HBME-1 was seen in 93.2% of carcinomas but in none of the benign nodules. Comparing follicular variant of papillary carcinoma (FVPC) with follicular carcinoma (FC), the expression of galectin-3, CK19, and HMWCK was significantly higher in FVPC. When comparing FC with FA, the expression of galectin-3 and HBME-1 was significantly higher in FC. These results suggest that 1) galectin-3 is a useful marker in the distinction between benign and malignant thyroid tumors, 2) the combined use of HBME-1 and CK19 can increase the diagnostic accuracy, and 3) the use of CK19 and HMWCK can aid in the differential diagnosis between PC and FC.

Topics: Adenocarcinoma, Follicular; Biomarkers, Tumor; Carcinoma, Papillary, Follicular; Cyclin D1; Cyclin-Dependent Kinase Inhibitor p27; Diagnosis, Differential; Galectin 3; Humans; Immunohistochemistry; Intracellular Signaling Peptides and Proteins; Keratin-19; Keratins; Sensitivity and Specificity; Thyroid Gland; Thyroid Nodule

The aim of the study was to evaluate the expression of galectin-3 (gal3), cytokeratin 19 (CK19), neural cell adhesion molecule (NCAM), and E-cadherin (Ecad) in thyroid gland tumors with follicular growth pattern with particular focus on their use in differential diagnosis. A series of 139 cases - 87 follicular adenomas (FAs), 26 follicular carcinomas (FCs), and 26 cases of the follicular variant of papillary carcinoma (FVPC) was studied. Expression of gal3 was found in 29/87 (33%) of FAs, in 13/26 (50%) of FCs, and in 24/26 (92%) of FVPCs. Expression of CK19 was found in 11/87 (13%) of FAs, in 4/26 (15%) of FCs, and in 17/26 (65%) of FVPCs. Expression of NCAM was found in 60/87 (69%) of FAs, in 20/26 (77%) of FCs, and in 7/26 (27%) FVPCs. Expression of Ecad was found in 81/87 (93%) of FAs, in 22/26 (85%) of FCs, and in 17/26 (65%) of FVPCs. The sensitivity and specificity of gal3 for malignancy were 0.70 and 0.85, of CK19 0.48 and 0.98, of NCAM 0.28 and 0.47, and of Ecad 0.48 and 0.20, respectively. A significant difference (p < 0.05) in expression of all studied markers between FVPC versus FA and FC was found, in contrast to FA and FC. Therefore, the use of gal3 and CK19 in differential diagnosis of FVPC versus FA and FC can be recommended.

Topics: Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Cadherins; Carcinoma, Papillary; Carcinoma, Papillary, Follicular; Diagnosis, Differential; Female; Galectin 3; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Neural Cell Adhesion Molecule L1; Thyroid Neoplasms

Since its description, hyalinizing trabecular adenoma (HTA) of the thyroid has been a controversial entity. Some have considered it a unique entity, some have considered it a variant of papillary carcinoma (PC), and still others have considered it a nonspecific pattern that may be seen with a variety of thyroid lesions. Complicating the matter, studies demonstrating metastases have shown entities that do not appear to be HTAs as originally described, and molecular studies showing changes of PC have used methods that are not specific. This study reviews our experience with thyroid lesions that showed at least some histologic features of HTA and presents the immunohistochemical findings for these lesions using antibodies employed for the diagnosis of PC.. Our files were reviewed for all thyroid resection reports describing lesions with hyalinized or sclerotic stroma and a trabecular architecture within the diagnosis or diagnostic comment. All cases were reviewed and classified as either HTA or as different lesions based upon histologic features. Immunohistochemistry with antibodies to HBME1, CK19 and p63 was performed with all lesions and with a series of controls.. Eighteen thyroid lesions with prominent sclerosis or hyalinization and trabecular architecture were identified. Only 4 of these were found to completely match the histologic and cytologic descriptions of HTA by HE review. The other cases showed histologic features more compatible with other diagnoses including cellular adenomatoid nodule (5), follicular adenoma (4), follicular variant of PC (FVPC) (3), and epithelial neoplasm with features of FVPC (2). All HTAs lacked immunoreactivity for HBME1, CK19 and p63. All cases deemed to be adenomatoid nodules, follicular adenomas and epithelial neoplasms showed no immunoreactivity for HBME1 and CK19 and, of these, only a single AN showed immunoreactivity for p63. Cases deemed to be FVPCs showed diffuse immunoreactivity for HBME1 and CK19 and 1 reacted with antibodies to p63. Of control PCs and other thyroid lesions, reactivity for HBME1, CK19, and p63 was observed in 8/8, 7/7, and 7/8 and 3/27, 7/27, and 7/27 cases, respectively.. A sclerotic or hyalinized stroma with a trabecular growth pattern may be seen in a number of different thyroid lesions and, when seen, is usually a focal feature of a lesion other than HTA. Immunohistochemistry may be of assistance as cases of FVPC with prominent hyalinization and trabeculation will show immunoreactivity for HBME1 and CK19, whereas HTAs and other thyroid lesions with hyalinization and trabeculation will not.

Topics: Adenoma; Biomarkers, Tumor; Carcinoma, Papillary, Follicular; Diagnosis, Differential; Humans; Hyalin; Immunohistochemistry; Keratins; Sclerosis; Thyroid Neoplasms

To study immunohistochemical expression of cytokeratin19 (CK19), galectin-3 (Gal-3) and HBME-1 in thyroid lesions and to assess their usefulness as markers in the differential diagnoses of thyroid nodular lesions.. Immunohistochemical staining was performed on formalin-fixed paraffin-embedded tissue of 21 cases of nodular goiters, 14 cases of toxic goiters, 15 cases of follicular adenomas (FA), 13 cases of follicular carcinomas (FC), 13 cases of follicular variant papillary carcinomas (FVPC) and 48 cases of classic papillary carcinomas (CPC).. All three markers were expressed in the cytoplasm with no or weak expression in benign lesions and diffuse and strong in malignant cases. Positive expressions of CK19, Gal-3 and HBME-1 were present in 11of 21, two of 21, four of 21 in nodular goiters, seven of 14, one of 14, one of 14 in toxic goiters, nine of 15, two of 15, two of 15 in FA, 10 of 13, eight of 13, seven of 13 in FC, 13 of 13, 11 of 13, 12 of 13 in FVPC, and 48 of 48, 45 of 48, 46 of 48 in CPC. The expression rates of the three markers between benign lesions (nodular goiters, toxic goiters and FA) and malignant lesions (FA, FVPC and CPC) were statistically significant. Among the three follicular lesions (FA, FC and FVPC), the differences were statistically significant as well. Nine, seven and six cases were negative for all three markers in nodular goiters, toxic goiters and FA, respectively. Only one case in FC was negative for all three markers, no case was all negative in FVPC and CPC; the rate of one case with two or more positive marker expression in nodular goiters, toxic goiters, FA, FC, FVPC and PC was 14.2% (3/21), 21.43% (3/14), 20.0% (3/15), 69.2% (9/13), 92.3% (12/13), 100.0% (48/48), the differences between benign lesions and malignant lesions and between FA, FC and FVPC were also statistically significant.. Immunohistochemical stains of CK19, Gal-3 and HBME-1, especially when used in combination, can be an important adjunct to the histopathological diagnoses of thyroid lesions.

Topics: Adenocarcinoma, Follicular; Adenoma; Biomarkers, Tumor; Carcinoma, Papillary, Follicular; Diagnosis, Differential; Galectin 3; Goiter, Nodular; Humans; Immunohistochemistry; Keratins; Thyroid Neoplasms; Thyroid Nodule

To study the expression of cytokeratin 19 (CK-19), HBME-1 and Ret in follicular-patterned thyroid tumors, and their significance for the diagnosis of the follicular variant of papillary thyroid carcinoma.. 111 well-differentiated follicular tumors were examined by immunohistochemistry: 59 papillary carcinomas (43 of the follicular variant), 40 follicular adenomas (among which 11 atypical adenomas), 10 oxyphil cell tumors and 2 follicular carcinomas.. CK-19 was diffusely expressed in all the papillary carcinomas, and was also expressed in 2/4 oxyphil cell carcinomas and 4/11 atypical adenomas. 90% of the follicular adenomas (26/29), the six oxyphil cell adenomas and the two follicular carcinomas showed at best a focal staining of dystrophic areas. 78% of the papillary carcinomas and 3/11 atypical adenomas were stained with HBME-1, whereas 26/29 adenomas (90%) and the 10 oxyphil cell tumors were negative. 34% of the papillary carcinomas expressed Ret (most of them were of the usual type (14/20)). The staining was often weak and focal (13/20). The other tumors were all negative for Ret.. CK-19 is a sensitive (100%) and specific (82.5%) marker of papillary carcinomas, which can be helpful in the diagnosis of its follicular variant. HBME-1 can improve this specificity when associated with CK-19. The Ret protein expression is of limited practical interest.

Topics: Adenoma; Adenoma, Oxyphilic; Biomarkers, Tumor; Carcinoma, Papillary; Carcinoma, Papillary, Follicular; Diagnosis, Differential; Drosophila Proteins; Humans; Immunohistochemistry; Keratins; Oxyphil Cells; Proto-Oncogene Proteins; Proto-Oncogene Proteins c-ret; Receptor Protein-Tyrosine Kinases; Thyroid Neoplasms

The follicular variant of papillary thyroid carcinoma (FV-PTC) may be difficult to differentiate from other thyroid neoplasms with follicular architecture such as follicular adenoma, follicular carcinoma, and dominant nodules in nodular goitre. Obvious differences in treatment and expected outcome between these lesions mandate that the distinction between them be made accurately. To decrease the subjectivity of this differential diagnosis, we undertook this study to determine if any difference in cytokeratin profile exists between FV-PTC and other follicular lesions of the thyroid gland.. Immunohistochemical analysis based on a retrospective pathology review.. Vancouver General Hospital, Vancouver, BC.. The files of the Vancouver General Hospital anatomic pathology laboratory were searched for cases of typical papillary thyroid carcinoma (PTC), FV-PTC, follicular adenoma, follicular carcinoma, and nodular goitre. The slides and reports were reviewed, and those cases with confirmed diagnosis and adequate tissue were selected for inclusion in the study. Monoclonal antibodies to cytokeratin 19 (CK19), 20 (CK20), and 7 (CK7) were applied to formalin-fixed, paraffin-embedded tissue sections.. All cases of PTC, including FV-PTC, as well as all follicular adenomas, follicular carcinomas, and nodular goitres, stained positively for CK7 and, except for a single follicular carcinoma, were negative for CK20. CK19 decorated almost all PTCs, including FV-PTC, although the staining was sometimes focal. The majority of the cases of follicular adenoma, follicular carcinoma, and nodular goitre were negative or showed focal staining with CK19, although occasional cases showed diffuse positivity.. CK19 strongly stains the majority of PTC, including FV-PTC, in a diffuse manner. However, overlap with the staining seen in other follicular lesions limits its utility in a routine diagnostic setting.

Topics: Carcinoma, Papillary, Follicular; Diagnosis, Differential; Humans; Immunohistochemistry; Keratins; Thyroid Gland; Thyroid Neoplasms

The morphologic distinction between papillary and follicular neoplasms of the thyroid gland can be difficult, especially on small biopsy specimens or in fine-needle aspirations. To determine whether immunohistochemistry could help in achieving the correct diagnosis, we characterized the staining pattern for a series of papillary and follicular neoplasms of the thyroid gland. A pilot study was performed using a panel of antibodies, including high-molecular-weight keratin (HMWK, 34 beta E12), cytokeratin (CK) 5/6, CK7, CK13, CK14, CK20, AE1/AE3, CAM5.2, involucrin, and villin. Of these antibodies, involucrin and HMWK showed strong differential staining between follicular and papillary neoplasms. HMWK stained 91% of papillary carcinomas, including follicular variants, with a median of 53% positive cells, and involucrin stained 72.5% of papillary neoplasms with a median of 45% positive cells. HMWK stained only 20% of follicular neoplasms, whereas involucrin stained 29% of cases. Papillary neoplasms showed strong, although patchy, staining with HMWK and involucrin, whereas those follicular neoplasms that did have staining showed a weak, diffuse pattern of staining. We believe that HMWK, and involucrin to a lesser degree, could be useful in differentiating papillary from follicular neoplasms, especially for cytologic cell block material or for cases in which the architectural pattern is follicular.

Topics: Adenocarcinoma, Follicular; Biomarkers, Tumor; Carcinoma, Papillary; Carcinoma, Papillary, Follicular; Diagnosis, Differential; Humans; Immunohistochemistry; Keratins; Protein Precursors; Thyroid Neoplasms