No abstract available.

We report a case of hyalinizing trabecular adenoma of the thyroid gland with its immunohistochemical and ultrastructural features. A 53 year-old euthyroid woman presented a well defined small cold nodule on a thyroid iodine scan. Microscopically, oval and elongated tumor cells were arranged in trabeculae, clusters and a "zellballen" pattern resembling paraganglioma with scattered follicles. Nuclear features were characterized by fine nuclear grooves, acidophilic intranuclear cytoplasmic inclusions and perinucleolar halos. Abundant extracellular eosinophilic fibrohyaline matrix resembling amyloid were also noted. Immunostaining of tumor cells was positive for thyroglobulin and negative for calcitonin. In addition, tumor cells displayed an unexpected, unique cytoplasmic immunoreactivity for MIB1. Electron microscopy revealed euchromatic nuclei with grooves, intranuclear cytoplasmic inclusions, intermediate filament stuffed cytoplasms and abundant extracellular basal lamina material.
Adenoma* ; Amyloid ; Basement Membrane ; Calcitonin ; Cytoplasm ; Eosinophils ; Female ; Humans ; Hyalin* ; Inclusion Bodies ; Intermediate Filaments ; Iodine ; Microscopy, Electron ; Middle Aged ; Paraganglioma ; Thyroglobulin ; Thyroid Gland*

Among 545 surgically treated Graves' disease patients, 17 were found to have coexisting thyroid neoplasms. Of these 17 patients, 11 turned out to have thyroid carcinomas. These patients could be divided into 2 groups; Group I with a diffusely enlarged gland with a clinically palpable nodule (n = 6) and Group II without a palpable nodule (n = 5). In Group I, 4 patients were diagnosed by preoperative fine needle aspiration cytology, and the remaining 2 by intraoperative frozen-section examination. In Group II, none of the patients were suspected of any concurrent thyroid carcinoma preoperatively, and only 2 were identified by intraoperative frozen-section examination. Thus, 8 of the 11 patients were diagnosed preoperatively or intraoperatively. These observations suggest that in all patients with Graves' disease and concurrent thyroid nodules, the suspicion of associated malignancy may be raised. And also, fine needle aspiration cytology in every case of Graves' disease with a palpable nodule and intraoperative frozen-section examination of the suspicious lobe in the cases of non-palpable nodules appear worthwhile in detecting a concurrent thyroid carcinoma.
Adult ; Aged ; Biopsy, Needle ; Female ; Frozen Sections ; Graves' Disease/*complications ; Human ; Intraoperative Period ; Male ; Middle Age ; Thyroid Neoplasms/*complications/*pathology

Thyroid cancer is a hot issue in Korea because there is debate on screening and diagnosis of thyroid cancer. Therefore, we reviewed the guidelines for the management of thyroid nodules of other countries. Western countries accepted the criteria of fine needle aspiration including the tumor size of thyroid nodules, although ultrasonographic morphologic characteristics are more important to diagnose the thyroid cancer than tumor size. This recommendation is based on good prognosis of papillary thyroid microcarcinoma. However, small subset of papillary thyroid microcarcinoma has aggressive behavior, which we cannot discern from those with benign behavior before operation. Therefore, further researches are necessary to resolve these problems and improve the management of papillary thyroid cancer avoiding overtreatment and mismanagement.
Biopsy, Fine-Needle* ; Diagnosis ; Korea ; Mass Screening ; Prognosis ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule*

Poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC) have poor prognosis and rare incidence compared to well differentiate thyroid cancer. Since the original description of PDTC in 1983, PDTC was introduced as a separate entity in the 2004 WHO Classification of Endocrine Tumors. PDTC was defined as a thyroid cancer with thyroglobulin-producing non-follicular non-papillary growth pattern and high-grade features, having an intermediate behavior between well differentiated thyroid cancer (WDTC) and ATC. But the criteria of PDTC are still controversial and heterogeneously applied in the diagnostic practice. Also the modalities of treatment, such as the extent of thyroid surgery, the use of radioiodine therapy and external radiation therapy are still controversial. ATC is rapidly progressing human carcinoma with a median survival of 4 to 12 months after diagnosis. Although the complete resection combined with external radiation therapy was reported to be effective recently and multimodality treatment has been recommended, current treatment of ATC has not been adequate for controlling the diseases. Therefore there are new attempts for treatment, such as chemotherapy with paclitaxel, clinical trials of combretastatin 4 phosphate and CS-7107 and multitargeted therapy of bevacizumab with doxorubicin, sorafenib, sunitinib etc. PDTC and ATC are an unexplored field like this, therefore, the studies for molecular pathology and therapeutic approach are necessary for improving survival and quality of life of patients.
Antibodies, Monoclonal, Humanized ; Bevacizumab ; Bibenzyls ; Doxorubicin ; Humans ; Incidence ; Indoles ; Niacinamide ; Paclitaxel ; Pathology, Molecular ; Phenylurea Compounds ; Prognosis ; Proline ; Pyrroles ; Quality of Life ; Thiocarbamates ; Thyroid Gland ; Thyroid Neoplasms

Thyroid microcarcinoma(TMC) is defined by the World Health Organization as carcinoma 1.0cm or less in its greatest dimension. TMC is being found in an increasing proportion of treated thyroid carcinomas due to the more frequent use and the technical improvement of ultrasonography and fine needle aspiration biopsy. Clinicians should be aware of the differences between TMC and clinical thyroid cancer (more than 1cm in diameter) when making a surgical decision. The aims of this study are to characterize the clinical and biological behaviors of TMC, to demonstrate the prognosis according to the risk factors and treatment modality, and to suggest a proper surgical management of TMC.
Biopsy ; Biopsy, Fine-Needle ; Prognosis ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Ultrasonography ; World Health Organization

PURPOSE: The goal of this study was to evaluate the diagnostic accuracy of preoperative fine needle aspiration biopsy cytology (FNAB-C) in predicting lateral lymph node metastasis in papillary thyroid cancer patients. METHODS: A total of 592 patients who underwent thyroid cancer surgery and intra-operative lateral cervical LN frozen section or RND, from January 2002 to December 2011, were evaluated retrospectively. Among them, 228 cases had suspicious findings in FNAB-C of lateral nodes. We reviewed their radiological and pathological reports. RESULTS: Intra-operative frozen section examination was performed in 540 cases and RND was performed in 314 cases. This study included 534 women (83.4%) and 106 men (16.6%). Patients' ranged in age from 9 to 83 years (mean, 45.65 years). FNAB-C was performed in 228 cases. The sensitivity and specificity of FNAB-C was 71.5% and 78.6%, respectively; 35.9% of cases had a false negative result. The combination of FNAB-C and intra-operative frozen section test sensitivity and specificity was 87.2% and 93.6%, respectively. CONCLUSION: The results for sensitivity in FNAB-C actually appear low, and false negative results were very high. In papillary thyroid cancer in patients with FNAB-C, even if the result is negative, if lymph node metastasis is suspected based on radiologic evidence, frozen section examination should be performed for determination of metastasis.
Biopsy ; Biopsy, Fine-Needle ; Female ; Frozen Sections ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis* ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms*

Thyroid nodules are the most common endocrine tumor. Ultrasonography and fine-needle aspiration (FNA) are currently accurate diagnostic tools for evaluating thyroid nodules. However, 10–30% of FNA specimens are cytologically indeterminate. Making an accurate diagnosis between benign and malignant nodules is important so that patients with malignant nodule receive proper treatment and patients with benign nodule can avoid unnecessary treatment. Several genetic changes such as point mutations of the BRAF or RAS and rearrangements of the RET/PTC1, RET/PTC3, PAX8/PPARY are used to adjust to indeterminate FNA. Such a mutational analysis has an excellent positive predictive value (PPV), but there is a weakness in the low negative predictive value (NPV). Gene-expression classifier (GEC) has been found helpful in identify nodules that are benign rather than malignant. GEC has an excellent NPV, but there is a weakness of low PPV. Multiplatform mutational and miRNA test (MPT) and next-generation sequencing assay (NGS) are being studied to compensate for these weaknesses. Molecular tests appear to be a good solution for improving the accuracy of indeterminate FNA cytology specimens and support the clinical management decisions in patients with indeterminate cytologic nodules, but further prospective multicenter trials are required for validation of reported findings and need evaluation of cost-effectiveness. This paper will review recently available molecular diagnostic tools of thyroid nodule.
Biopsy, Fine-Needle ; Diagnosis ; Humans ; MicroRNAs ; Multicenter Studies as Topic ; Pathology, Molecular ; Point Mutation ; Prospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography

Graves disease occur in association with myasthenia gravis is rare. We report a case of Graves disease and myasthenia gravis treated by bilateral subtotal thyroidectomy and total thymectomy simultaneously. A 37 year old woman was admitted with anterior neck mass and ptosis. Various examinations were compatible with combined Graves disease and myasthenia gravis. The bilateral subtotal thyroidectomy and total thymectomy were done simultaneously. The pathologic diagnosis was Graves disease and thymic hyperplasia. The patients postoperative course was uneventful. The thyroid function of patient became euthyroid and the clinical symptoms related with myastenia gravis resolved during follow up period.
Adult ; Diagnosis ; Female ; Follow-Up Studies ; Graves Disease* ; Humans ; Myasthenia Gravis* ; Neck ; Thymectomy* ; Thymus Hyperplasia ; Thyroid Gland ; Thyroidectomy*

BACKGROUND: Tumor growth and metastasis depend on angiogenesis. Angiogenesis correlates with the expression of vascular endothelial growth factor (VEGF) and with the prognosis in some cancers. Angiogenesis may also play an important role in the growth and the metastasis of thyroid cancer. We determine whether the expression of VEGF and its receptors (flk-1/KDR, flt-1) correlates with vascularity, invasion to adjacent structure and lymph node metastasis of thyroid cancers. METHODS: Sixty-five specimens obtained from patients with benign thyroid disease and thyroid cancers investigated by immunohistochemical staining for factor VIII, VEGF, flk-1/KDR and flt-1. Vessels were counted by light microscopy (x200), and the intensity of staining for VEGF and receptors was assessed on a scale of 1 to 4 . Correlations between the expression of VEGF, microvessel density and various clinicopathologic factors were analyzed. RESULTS: 1) There were no differences in microvessel counts and expressions of VEGF and its receptors among sex, age and tumor size. 2) Microvessel counts in thyroid cancers (mean SD: 91.1+/-30.4, x200), especially anaplastic cancers (159.0+/-14.1) were higher than in follicular adenomas (56.3 13.6). 3) The expressions of VEGF, flk-1/KDR and flt-1 were higher in thyroid cancers (2.7+/-1.0, 2.1+/-0.9, 2.2+/-0.9) than in follicular adenomas (1.4+/-0.5, 1.4+/-0.5, 1.4+/-0.5), the expressions of VEGF, flk-1/KDR and flt-1 in anaplastic cancers (3.8+/-0.5, 3.8+/-0.5, 3.5+/-0.6) were higher than in differentiated cancers (papillary and follicular). But there were no differences of microvessel density and the intensity of VEGF, flk-1/KDR and flt-1 expression between absence and presence of the invasion to adjacent structure and lymph node metastasis in cancers. 4) The intensity of VEGF expression correlated with microvessel densities and that of its receptors. CONCLUSION: Angiogenesis and VEGF expression in thyroid cancer correlated with the grade of differentiation. But we did not found any differences in angiogenesis and VEGF expression with or without invasion to adjacent structures and lymph node metastasis in differentiated thyroid cancer. In the future, further study, including recurrent and distant metastatic thyroid cancers, will be needed.
Adenoma ; Factor VIII ; Humans ; Lymph Nodes ; Microscopy ; Microvessels* ; Neoplasm Metastasis ; Prognosis ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Neoplasms* ; Vascular Endothelial Growth Factor A*