BACKGROUND AND OBJECTIVES: The relationship between Hashimoto thyroiditis (HT) and papillary thyroid cancer (PTC) is still controversial. Some studies suggested that molecular basis of the association between HT and PTC. BRAF(V600E) mutation is the most common genetic alteration founded in PTC. This study was to determine a role of BRAF(V600E) mutation in PTC with concurrent HT and their association with other clinicopathological factors. MATERIALS AND METHODS: We enrolled 452 patients who underwent thyroid surgery between 2009 and 2012 for classical PTC. The status of BRAF(V600E) mutation was evaluated by direct sequencing. HT was defined as presence of lymphocytic thyroiditis in pathology or positive serum anti-thyroid peroxidase antibody. RESULTS: Total 139 patients (30%) with PTC had coexistence HT. HT was significantly associated female (p=0.006), and younger age (p=0.045). BRAF(V600E) mutation was confirmed in 264 patients (58%). The frequency of BRAF(V600E) mutation was significantly lower in PTC with coexistence HT (48.2%) compared by PTC without HT (62.9%, p=0.004). However, there was no significant difference in clinicopathological feature of PTC according to the presence of HT in patients with BRAF(V600E) mutated PTC. BRAF(V600E) mutation was less frequent in PTC with coexistence HT. CONCLUSION: These findings suggested that HT and BRAF(V600E) mutation might be independent factors in development and progression of PTC.
Female ; Hashimoto Disease* ; Humans ; Pathology ; Peroxidase ; Thyroid Gland ; Thyroid Neoplasms ; Thyroiditis, Autoimmune

Hashimoto's thyroiditis (HT) is a autoimmune disease that is highly incident year by year. Its clinical manifestations are alternative hyperthyroidism or hypothyroidism, relatively high Th1, excessively low Th2 and constantly increasing TGAb and TMAB. Currently, the disease is still difficult to be cured, and instable thyroid function makes it harder to be treated. Therefore, this essay makes a summary analysis on domestic and foreign studies on HT's pathogenesis, clinical manifestations and treatment, resulting that pure supplement or immunosuppressive therapy is hard to achieve notable efficacy, while existing traditional Chinese medicines could only mitigate clinical symposiums but did not reduce inflammation. Therefore, to look for methods and drugs for adjusting immunity imbalance by decreasing Th1 cell factors and increasing Th2 cell factors is significant to HT treatment to some extent.
Animals ; Autoantibodies ; immunology ; Female ; Humans ; T-Lymphocytes, Helper-Inducer ; immunology ; Thyroiditis, Autoimmune ; drug therapy ; immunology ; pathology

To determine the content of thyroglobulin in oxyphilic cells of the thyroid, which have been considered as non-thyroglobulin producing cells, the degree of stainability of the various oxyphilic cells for thyroglobulin was compared with that of non-oxyphilic follicular cells in either same or different lesion. A total of 13 oxyphilic lesions, including three follicular adenomas containing oxyphilic cell nodules, four pure oxyphilic cell adenomas, and six Hashimoto's thyroiditis were compared with 16 of non-oxyphilic lesions such as, seven follicular adenomas, four chronic lymphocytic thyroiditis, and five Graves' disease. Many oxyphilic cells stained positively for thyroglobulin regardless of their morphologic variation, but less intensely than the usual follicular cells in follicular adenomas, chronic lymphocytic thyroiditis, and Graves' disease. The stainability of oxyphilic cells for thyroglogulin did not show any significant correlation with morphologic features, whereas in follicular adenomas, the non-oxyphilic follicular cells forming microfollicles stained less strongly for thyroglobulin than the same cells lining large mature follicles in a reproducible way. With above findings, we concluded that oxyphilic cells maintain the functional activity in terms of thyroglobulin synthesis, although the content of the thyroglobulin is less than that of non-oxyphilic colloid forming follicular cells.
Adenoma/*metabolism/pathology ; Graves Disease/*metabolism/pathology ; Humans ; Staining and Labeling ; Thyroglobulin/*biosynthesis ; Thyroid Neoplasms/pathology ; Thyroiditis, Autoimmune/*metabolism/pathology

We have reviewed 1066 thyroid lesions and compared the relative incidence of the so called 'palpation thyroiditis' between autoimmune thyroiditis and normal thyroid parenchyme surrounding the nodular thyroid lesion and also discussed the pathogenesis of palpation thyroiditis. The typical histopathologic features of 'palpation thyroiditis' were seen in 275 cases among 467 adenomatous goiters and in none of the autoimmune thyroiditis. We here in this paper suggest that the so called 'palpation thyroiditis' is not merely a secondary phenomenon to mechanical follicular damage by vigorous palpation, but this lesion more likely develops in conditions where certain types of physiologic alteration has occurred in follicular basement membrane, just like a pathogenesis of subacute granulomatous thyroiditis.
Adenocarcinoma/complications/pathology ; Adenoma/complications/pathology ; Carcinoma, Papillary/complications/pathology ; Diagnosis, Differential ; Goiter, Nodular/complications/pathology ; Humans ; *Iatrogenic Disease ; Palpation/*adverse effects ; Thyroid Gland/*injuries/pathology ; Thyroid Neoplasms/complications/*pathology ; Thyroiditis/diagnosis/etiology/*pathology ; Thyroiditis, Autoimmune/*pathology

Apoptosis is responsible for the loss of thyrocytes in autoimmune thyroiditis. Recent investigations into the pathogenesis of apoptosis have revealed that the important roles of suicide molecules expression on both thyrocytes and cytotoxic T-lymphocytes. To study the mechanism of thyrocyte loss in various forms of thyroiditis, we evaluated in situ expression patterns of CD40, Fas, and Fas-L on thyrocytes and infiltrating inflammatory cells by immunohistochemical staining of thyroid samples obtained from 49 patients (Graves' disease, n=10 : Hashimoto's thyroiditis, n=14; nonspecific lymphocytic thyroiditis, n=11; subacute granulomatous thyroiditis, n=11; normal, n=3). The role of cytotoxic T-lymphocytes was also evaluated by analyzing the expression of granzyme B along with their phenotypic characteristics. CD40 was not expressed on thyrocytes of normal controls while they showed a diffuse expression of Fas and a scattered focal expression of Fas-L. The plump thyrocytes proximal to the inflammatory infiltrates showed more intense expressions of these three molecules in various forms of thyroiditis and a close correlation was found between CD40 and Fas-L expression on thyrocytes. Unlike Fas, which was expressed on infiltrating lymphocytes in all groups, Fas-L was not expressed on infiltrating lymphocytes, except those in subacute granulomatous thyroiditis. Granzyme B expressing activated cytotoxic T-lymphocytes occupied a negligible proportion of CD8+ T-lymphocytes in various forms of thyroiditis, and no difference was found in terms of their proportions according to the type of thyroiditis. These results show the acquisition of CD40, Fas and Fas-L molecules on thyrocytes proximal to inflammatory cell aggregates and the negligible expression of granzyme B and Fas-L on the infiltrating lymphocytes, and suggest that Fas and Fas-L mediated apoptosis of thyrocytes (fratricide) may be more important than T cell-mediated cytotoxicity in various forms of thyroiditis.
Antigens, CD40/*metabolism ; Antigens, CD95/metabolism ; Apoptosis/*physiology ; Graves' Disease/*metabolism/pathology ; Human ; Membrane Glycoproteins/metabolism ; Reference Values ; Thyroiditis, Autoimmune/*metabolism/pathology

OBJECTIVETo study the immunoglobulin gene rearrangement patterns in Hashimoto's thyroiditis (HT) and primary thyroid lymphoma (PTL), and to analyze the relationship between the two diseases.

METHODSFormalin-fixed and paraffin-embedded tissues of 11 cases of PTL and 38 cases of HT as well as their clinical data, were retrieved. The latter group was further subcategorized into classic HT and suspicious PTL. Gene rearrangement studies for immunoglobulin heavy chains and light chains were carried out by polymerase chain reaction (PCR) using VH, FR3A and FR3kappa primers.

RESULTSThere was an increasing trend in immunoglobulin gene rearrangement rate for classic HT (10.7%), suspicious PTL (40.0%) and PTL (72.7%) groups. In general, a female predilection was observed. This sex predilection however was less obvious in the PTL group. There was no relationship between serum antibody (both thyroglobulin and thyroid peroxidase) titers and gene rearrangement patterns.

CONCLUSIONSHT and PTL show morphologic overlaps and may not be clearly distinguished on the basis of light microscopy alone. PCR-based immunoglobulin gene rearrangement study may be helpful in the detection of cases with early lymphomatous transformation of HT.

Female ; Gender Identity ; Gene Rearrangement ; Hashimoto Disease ; genetics ; Humans ; Lymphoma ; genetics ; pathology ; Male ; Middle Aged ; Sex Characteristics ; Thyroid Neoplasms ; genetics ; pathology ; Thyroiditis, Autoimmune ; genetics

PURPOSE: The diagnosis of Graves' disease can be clinically made by the findings of hyperthyroidism combined with eye signs or a diffusely enlarged goiter. The pathological findings of Graves' disease are hypertrophy and hyperplasia of the thyroid follicles. Surgical treatment for Graves' disease is indicated for patients with a suspicion of cancer, a large goiter, medical failure, patient preference or severe ophthalmopathy. The aim of this study is to determine the diagnostic accuracy of clinically diagnosed Graves' disease on the basis of the postoperative pathologic findings. METHODS: We performed a retrospective analysis of the medical records of the patients who were diagnosed as having Graves' disease since Jan 2000 at St. Mary's Hospital, The Catholic University of Korea. To confirm the pathological findings in this study, the patients who underwent surgical treatment were enrolled, and their preoperative diagnostic tests were also reviewed. RESULTS: A total of 57 patients with Graves' disease underwent surgery due to medical failure in 45 (78.9%), ophthalmopathy in 25 (43.8%), huge goiter in 4 (7%), suspicion of cancer in 4 (7%), and others in 4 (7%). Thirty nine (68.4%) patients were female and total thyroidectomies were performed in 52 (91.2%) patients. The pathological reports of the thyroid specimens showed diffuse hyperplasia in 53 (92.9%), nodular hyperplasia in 2 (3.5%), Lymphocytic thyroiditis in 1 (1.8%) and Hashimoto's thyroiditis in 1 (1.8%). The diagnostic accuracy of preoperative antimicrosomal Ab, anti-TSHR Ab and a technetium 99m thyroid scan was 73.8%, 86.0% and 69.7%, respectively. Papillary carcinoma was identified in 6 patients (10.5%). CONCLUSION: The microscopic findings of 5 patients (7.0%) who were diagnosed clinically as having Graves' disease were not compatible with the criteria for a pathological diagnosis. Surgical treatment and confirmation of the exact pathology should be performed for the appropriate treatment.
Carcinoma, Papillary ; Diagnosis ; Diagnostic Tests, Routine ; Female ; Goiter ; Graves Disease* ; Humans ; Hyperplasia ; Hyperthyroidism ; Hypertrophy ; Korea ; Medical Records ; Pathology ; Patient Preference ; Retrospective Studies ; Technetium ; Thyroid Gland ; Thyroidectomy ; Thyroiditis ; Thyroiditis, Autoimmune

BACKGROUND: Malignant follicular lesion is not differentiated from benign lesions cytologically. The objective of this study was to assess the rate and the risk of malignancy in thyroid nodules which were cytologically diagnosed as follicular neoplasm by fine-needle aspiration (FNA) cytology. METHODS: All the patients who had undergone surgery with cytological diagnosis of follicular neoplasm from January 1996 through December 2001 in Asan Medical Center were studied retrospectively. Patients' and nodule characteristics were analyzed for factors associated with the presence of cancer. Two hundred and fifteen patients (196 females, 19 males) were included and their mean age was 39.4 years (range: 12~76). RESULTS: About half of the patients (102 out of 215, 47.4%) had malignancy with 29 papillary carcinomas, 57 follicular carcinomas, 15 H rthle cell carcinomas and 1 medullary carcinoma. Previously suggested factors associated with risk for malignancy, such as male gender, large tumor size (> 4 cm) or age of patients (> 45 years), were not associated with increased risk. Diagnosis of H rthle cell neoplasia on FNA was also not associated with increased risk. Only the extremes in age of the patients (below 20 or above 60 years) were associated with increased risk for malignancy. CONCLUSION: In our findings, prevalence of carcinoma in thyroid nodule patients with cytological diagnosis of follicular neoplasm was much higher than those reported. Clinical characteristics, such as male gender, age and nodule size, are not useful predictors for the presence of malignancy. Thyroid nodules with cytological diagnosis of follicular neoplasm warrant immediate surgery.
Adenocarcinoma, Follicular/pathology ; Adenoma, Oxyphilic/pathology ; Adolescent ; Adult ; Age Factors ; Aged ; Biopsy, Needle ; Carcinoma, Medullary/pathology ; Carcinoma, Papillary, Follicular/pathology ; Child ; Female ; Human ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms/*pathology ; Thyroid Nodule/*pathology ; Thyroidectomy ; Thyroiditis, Autoimmune/pathology

Eosinophilic fasciitis (EF) is scleroderma-like disease without Raynaud's phenomenon or visceral involvement. It is characterized by painful swelling of the extremities, accompanied by rapid weight gain, fever and myalgia. The acute state of disease is associated with significant peripheral blood eosinophilia, an elevated erythrocyte sedimentation rate and hypergammaglobulinemia. EF is also frequently associated with hematological abnormalities, including malignant lymphoproliferative diseases, but rarely associated with autoimmune thyroiditis. In the present study we report a case of eosinophilic fasciitis associated with autoimmune thyroiditis.
Biopsy ; Diagnosis, Differential ; Eosinophilia/diagnosis/*etiology ; Fasciitis/diagnosis/*etiology ; Female ; Forearm ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Muscle, Skeletal/pathology ; Thyroiditis, Autoimmune/*complications/diagnosis

Chronic HCV infection has been reported to be associated with several extrahepatic conditions such as cryoglobulinemia, lymphoma, lichen planus, porphyria cutanea tarda, autoimmune thyroiditis, and renal disease. Glomerular disease may occur in patients with chronic HCV infection. The most common patterns are membranoproliferative glomerulonephritis, and less frequently, membranous nephropathy, fibrillary glomerulonephritis and immunotactoid glomerulopathy. Few crescentic glomerulonephritis has been reported in association with HCV infection, and no case was reported in Korea yet. We experienced one case of rapidly progressive glomeruloinephritis with the pathology of crescentic glomerulonephritis complicated in membranoproliferative glomerulonephritis in a patient with HCV infection.
Cryoglobulinemia ; Glomerulonephritis* ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Korea ; Lichen Planus ; Lymphoma ; Pathology ; Porphyria Cutanea Tarda ; Thyroiditis, Autoimmune