Adenocarcinoma, Follicular/diagnosis* ; Diagnosis, Differential ; Humans ; Metabolomics ; Thyroid Neoplasms/therapy*

BACKGROUND: Currently, in follicular lesion of aspirates of thyroid, pathologic evaluation of surgical specimen is the only diagnostic method whether the patient had follicular thyroid malignancy or not. The aim of this study is the evaluation of the clinical utility of HBME-1 immunostaining in the diagnosis of follicular thyroid malignancy in surgical specimen, and to establish the diagnostic guideline of HBME-1 immunostaining. METHODS: From 1994 to Sep. 1999, the 72 paraffin embedded tissue, which was already diagnosed as thyroid follicular carcinoma or adenoma through the pathologic evaluation of surgical specimen, were studied. Among 72 specimens, the 29 follicular carcinoma were included, and the others were follicular adenoma. The specimens were stained with HBME-1 monoclonal antibody by standard avidin-biotin peroxidase complex methods. One limited pathologist had read the findings of the immunostaining with a basis such as percent of tumor area. These percentage were divided to 4 grade as follows: 1) Grade 0: negative stained, 2) Grade 1: stained area < 30%, 3) Grade 2: 30 < or = stained area < 60%, and 4) Grade 3: stained area > or = 60%. After we had set a basis of follicular carcinoma as more than Grade 2, defined the clinical utility of HBME-1 immunostaining. The clinical utility was based that the concordance rate between pathologic diagnosis and the findings of immunostaining was more than 80% in both groups. RESULTS: 1) There was significant difference between two groups in intensity of cellular staining (p=0.04, x2). But, there might not be helpful to rule out follicular carcinoma of thyroid from adenoma in fine-needle aspirates. 2) In both groups, the percent of stained area of tumor was very diverse from 0% to 100%, and was statistically significant different (p=0.007). 3) Because the only 5 cases of normal tissue in both groups were stained weakly, the HBME-1 immunostaining was like to specific reaction with tumor tissue in both groups. 4) When we had set a basis of follicular thyroid carcinoma as more than Grade 2 (> or = 30%), the concordance rate between pathologic diagnosis and the findings of immuno- staining was 69.7% in follicular adenoma, 65.5% in follicular carcinoma, respectively. CONCLUSION: The HBME-1 immunostaining may not be help to differentiate follicular carcinoma from adenoma.
Adenocarcinoma, Follicular ; Adenoma ; Diagnosis* ; Humans ; Paraffin ; Peroxidase ; Thyroid Gland*

Minimally invasive follicular thyroid carcinoma (MIFTC) is a subtype of follicular thyroid carcinoma. The definition of MIFTC is somewhat confusing; as a result, diagnosis of MIFTC is difficult. MIFTC is known to have an excellent prognosis. Thus, no further treatment is usually required after diagnostic lobectomy. However, some patients with MIFTC experience distant metastasis after initial lobectomy. In this review, we will discuss the definition of MIFTC and risk factors of distant metastasis after initial lobectomy.
Adenocarcinoma, Follicular* ; Diagnosis ; Humans ; Neoplasm Metastasis ; Prognosis ; Risk Factors ; Thyroid Neoplasms

Adenocarcinoma, Follicular ; Adolescent ; Adult ; Child ; Humans ; Thyroid Neoplasms ; diagnosis ; epidemiology ; Young Adult

Adenocarcinoma, Follicular ; classification ; diagnosis ; pathology ; Carcinoma, Papillary ; diagnosis ; pathology ; surgery ; Humans ; Lymphatic Metastasis ; Thyroid Neoplasms ; diagnosis ; pathology ; surgery

BACKGROUND: Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy and its differential diagnosis includes follicular adenoma (FA) and adenomatous goiter (AG). Several ancillary markers have been suggested to aid in the diagnosis of FTC, but the successful use of these methods still needs to be validated. METHODS: In the present study, we verified the immunoexpression of HMGA2, CEACAM6, survivin, and SFN/14-3-3 delta in lesions including 41 AGs, 72 FAs, and 79 FTCs. We evaluated their diagnostic usefulness, combined with galectin 3, Hector Battifora mesothelial 1 (HBME1), cytokeratin 19, and cyclin D1, in diagnosing FTC. RESULTS: The expressions of HBME1 (65.8%) and HMGA2 (55.7%) were significantly higher in FTCs than in FAs and AGs (p<.001 and p=.005, respectively). HBME1 was the only marker that was more frequently expressed in FTCs than in FAs (p=.021) and it was more frequently expressed in follicular neoplasms than in AGs (p<.001). Among the novel markers, the combination of HMGA2 and HBME1 showed the highest sensitivity (72.2%) and specificity (76.1%) for diagnosing FTC. CEACAM6, survivin, and SFN/14-3-3 delta were barely expressed in most cases. CONCLUSIONS: Our present results show that only HMGA2 can be beneficial in differentiating FTC using the novel markers.
Adenocarcinoma, Follicular* ; Adenoma ; Cyclin D1 ; Diagnosis ; Diagnosis, Differential ; Galectin 3 ; Goiter ; Keratin-19 ; Sensitivity and Specificity ; Thyroid Gland

Adenocarcinoma, Follicular ; diagnosis ; pathology ; Adenoma ; diagnosis ; pathology ; Carcinoma, Papillary ; diagnosis ; pathology ; Carcinoma, Papillary, Follicular ; diagnosis ; pathology ; Cell Nucleus ; pathology ; Diagnosis, Differential ; Humans ; Neoplasm Invasiveness ; Thyroid Gland ; pathology ; Thyroid Neoplasms ; diagnosis ; pathology ; Thyroid Nodule ; diagnosis ; Thyroiditis ; diagnosis

Angiosarcoma of the thyroid has long been a controversial entity, and it is histologically defined as cleft-like anastosmosing spaces lined by large, atypical cells of endothelial lineage. However, clear-cut separation between the angiosarcoma and anaplastic carcinoma of the thyroid is difficult because they yield nearly the same clinical prognosis and overlapping histologic findings. We report a case of thyroid neoplasm composed of minimally invasive well differentiated follicular carcinoma and angiosarcoma with intervening transitional area. Immunohistochemically, the angiosarcomatous portion showed focal immunoreactivity for endothelial markers such as CD31, CD34, Ulex europaeus 1 lectin, factor VIII-related antigen, and immunonegativity for epithelial markers including pancytokeratin, epithelial membrane antigen and thyroglobulin, whereas the reverse was demonstrated in the minimally invasive follicular carcinomatous portion. The follicular carcinoma portion was positive for thyroid transcription factor-1 (TTF-1). Each component showed ultrastructural findings of epithelial and endothelial differentiation, respectively. The present case was unique in that angiosarcoma of the thyroid was confirmed by immunohistochemistry and electron microscopy, as well as light microscopy, and also coexisted with a minimally invasive well differentiated follicular carcinoma in the same mass. This combination has never been described in the literature. Although restricted to a single case, the present case further supports that angiosarcoma is a true existent entity rather than a variant of anaplastic carcinoma.
Adenocarcinoma, Follicular/*pathology ; Comorbidity ; Diagnosis, Differential ; Hemangiosarcoma/*pathology ; Human ; Male ; Microscopy, Electron ; Middle Aged ; Thyroid Neoplasms/*pathology ; Tumor Markers, Biological

PURPOSE: Follicular thyroid carcinoma (FTC) is the second most common malignancy of the thyroid after papillary thyroid carcinoma, constituting about 10% of all thyroid malignancies. The objective of the current investigation was to determine whether there was a direct relationship between the histologic degree of invasion, tumor recurrence, and patient survival. METHODS: We retrospectively reviewed the records of 55 patients with a histologic diagnosis of pure follicular carcinoma of the thyroid who were treated from 1990 to 2003 at the Presbyterian Medical Center in Jeonju, Korea. Their mean follow-up period was 8.4 years (range, 1~15 years). The following criteria were used to histologically define malignant follicular neoplasms: 1) minimally invasive, tumor invasion through the entire thickness of the tumor capsule; 2) moderately invasive, tumor with angioinvasion (with or without capsular invasion); and 3) widely invasive, broad area or areas of transcapsular invasion of thyroid and extrathyroid tissue. RESULTS: Among 33 patients with capsular invasion only, 2 patients (6%) developed recurrent disease. Of the 16 patients who had angioinvasion with or without capsular invasion, 4 patients (25%) developed recurrent disease. Among 6 patients who had widely invasive FTC, 5 patients (83%) developed recurrent disease, and 2 of those 6 patients (33%) with widely invasive FTC died of the disease. Patients who had widely invasive FTC had greater recurrence rates than patients who had a capsular or angioinvasion (P<0.001). The overall death rate for patients with widely invasive FTC was 33%. CONCLUSION: This study shows that patients with widely invasive FTC had greater recurrence rates and poorer survival than patients who had capsular or angioinvasion; this difference was statistically significant. The authors conclude that patients who had widely invasive FTC need close follow-up and active treatment.
Adenocarcinoma, Follicular* ; Diagnosis ; Follow-Up Studies ; Humans ; Jeollabuk-do ; Korea ; Mortality ; Prognosis* ; Protestantism ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms

OBJECTIVETo study immunohistochemical expression of GADD153 and assess its usefulness as markers in the differential diagnoses in follicular tumors of the thyroid.

METHODSImmunohistochemical staining was performed on formalin-fixed paraffin-embedded tissue of 34 cases of follicular thyroid adenomas (FTA), 46 cases of follicular thyroid carcinomas (FTC), 29 cases of follicular variant papillary carcinomas (FVPC).

RESULTS(1) GADD153 was expressed in cell nucleus with positive or strong positive expression in FTC, and no or weak expression in FTA and FVPC. The positive expressions of GADD153 were present in 38 of 46(82.6%) in FTC, 11 of 34(32.4%) in FTA and three of 29(10.3%) in FVPC, the positive expression rate in FTC was obviously higher than that in FTA and in FVPC, the differences were statistically significant (χ² = 20.80 and 37.48; P < 0.01). (2) CK19, Galectin-3 (Gal-3) and HBME-1 were all expressed in the cytoplasm, the positive expressions of CK19, Gal-3 and HBME-1 were present in 54.3% (25/46), 67.4% (31/46) and 58.7% (27/46) in FTC; 50.0% (17/34), 29.4% (10/34) and 32.4% (11/34) in FTA; 100% (29/29), 93.1% (27/29) and 89.7% (26/29) in FVPC, the differences were statistically significant as well (χ² = 21.20 and 8.22; P < 0.01). (3) According to the expressions of CK19, Gal-3, HBME-1 and GADD153, we divided the results into low expression group (0 or 1+) and high expression group (2+ or 3+), the sensitivity and the specificity were calculated. in FTA, the sensitivity were 26.5%, 8.8%, 2.9% and 11.8%; the specificity were 50.7%, 52.0%, 54.7% and 58.7%. in FTC, the sensitivity were 19.6%, 26.1%, 23.9% and 65.2%; the specificity were 41.3%, 57.1%, 62.0% and 92.1%. in FVPC, the sensitivity were 96.6%, 82.8%, 79.3% and 3.4%; the specificity were 77.5%, 81.3%, 85.0% and 57.5%.

CONCLUSIONSThe sensitivity and the specificity of GADD153 expression are well for diagnosing FTC, and CK19, Gal-3, HBME-1 are well for FVPC. The four markers when used in combination, are better to identify the follicular tumors of the thyroid.

Adenocarcinoma, Follicular ; diagnosis ; metabolism ; pathology ; Adenoma ; diagnosis ; metabolism ; pathology ; Biomarkers, Tumor ; metabolism ; Carcinoma, Papillary, Follicular ; diagnosis ; metabolism ; pathology ; Diagnosis, Differential ; Galectin 3 ; metabolism ; Humans ; Keratin-19 ; metabolism ; Sensitivity and Specificity ; Thyroid Neoplasms ; diagnosis ; metabolism ; pathology ; Transcription Factor CHOP ; metabolism