PURPOSE: To report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid. MATERIALS AND METHODS: Of the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy. RESULTS: Of the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies. CONCLUSION: TAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.
Adult ; Aged ; Autoantibodies/blood ; Carcinoma ; Carcinoma, Papillary/immunology/surgery ; Female ; Graves Ophthalmopathy/*diagnosis/immunology ; Humans ; Male ; Middle Aged ; Postoperative Complications/etiology/immunology/pathology ; Receptors, Thyrotropin ; Retrospective Studies ; Thyroid Neoplasms/complications/*surgery ; Thyroidectomy/adverse effects/*methods ; Thyrotropin/blood ; Treatment Outcome

OBJECTIVETo evaluate the prognostic impact of tumor size, ultrasonography, central neck lymph node involvement, and age of patients in papillary thyroid microcarcinoma (PTMC).

METHODSTwo hundred and fifty-four patients who underwent total thyroidectomy and central neck dissection for PTMC between 2012 and 2014 were included in this retrospective study. Statistical correlation between tumor size and various clinicopathological parameters was assessed by univariate and multivariate analyses. The ultrasound findings were also evaluated.

RESULTSA total of 254 patients (199 females and 55 males) were included in this study. PTMC showed a predilection for female patients, 41-50 years of age (43.3% of all cases, 110/254), and ultrasound showed hypoechoic nodules. Statistically significant correlation was demonstrated between central neck lymph node involvement and the following factors: age and tumor size. A tumor diameter greater than 0.5 mm (67.3% of all cases) most commonly occurred in patients older than 41 years, and was associated with a higher risk of metastatic central neck lymph node involvement (P<0.05). Hashimoto's thyroiditis was noted in the background in 39.4%(100/254) of cases.

CONCLUSIONSTumor size appears to have a prognostic impact in PTMC, and larger size is more likely to be associated with a higher risk of central neck lymph node involvement. It is controversial whether the etiology of papillary thyroid carcinoma is related to Hashimoto's thyroiditis.

Adult ; Age Factors ; Analysis of Variance ; Carcinoma ; Carcinoma, Papillary ; diagnostic imaging ; pathology ; surgery ; Female ; Hashimoto Disease ; diagnosis ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck ; Neck Dissection ; Prognosis ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; surgery ; Thyroidectomy ; Tumor Burden ; Ultrasonography

OBJECTIVETo study the clinicopathologic characteristics of parathyroid carcinoma (PTC).

METHODSEleven cases of PTC encountered during the period from 1994 to 2012 were enrolled into the study. Forty cases of parathyroid adenoma (PA) were also retrieved for comparison. The clinical manifestations, laboratory results and pathologic features were analyzed, with literature review.

RESULTSThe main clinical manifestations of PTC included neck mass (11/11), hypercalcemia (11/11) and hyperparathyroidism (11/11). Most patients also had osteoporosis (10/11). In contrast, PA often manifested as hypercalcemia (40/40) and hyperparathyroidism (40/40). Histologic examination of PTC showed that the tumor cells contained clear to eosinophilic cytoplasm and separated by dense bands of fibrosis. The tumor mass was surrounded by thick fibrous capsule. Foci of capsular invasion and vascular permeation were identified at the tumor periphery in all cases. Cellular atypia was not conspicuous but mitotic figures and coagulative necrosis were easily identified. On the other hand, PA were composed of tumor cells with clear to eosinophilic cytoplasm, forming glands, trabeculae or nests. Most of them (35/40) had intact fibrous capsule. Mitotic figures were rarely encountered and tumor necrosis was absent. Immunohistochemical study showed that the tumor cells in PTC were positive for CK19 (11/11), chromogranin A (9/11), synaptophysin (7/11) and parathyroid hormone (11/11). They were negative for thyroglobulin, TTF-1 and calcitonin. The Ki-67 index was less than 10% (range = 2% to 9%). In contrast, the tumor cells in PA were positive (40/40) for CK19, chromogranin A, synaptophysin and parathyroid hormone. They were negative for thyroglobulin, TTF-1 and calcitonin. The Ki-67 index was less than 3%. Follow up-data were available in 9 cases of PTC (duration of follow up = 11 months to 224 months) and 7 of the patients were still alive. Follow up of all PA cases showed no evidence of recurrence.

CONCLUSIONSPTC is a rare malignant endocrine tumor presenting as neck mass. Histologic features suggestive of malignant behavior include presence of coagulative tumor necrosis and capsular/vascular invasion. It needs to be distinguished from other entities such as parathyroid adenoma, papillary thyroid carcinoma and medullary thyroid carcinoma.

Adenoma ; metabolism ; pathology ; Adult ; Carcinoma ; metabolism ; pathology ; Carcinoma, Neuroendocrine ; Carcinoma, Papillary ; Chromogranin A ; metabolism ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Hypercalcemia ; etiology ; Hyperparathyroidism ; etiology ; Immunohistochemistry ; Keratin-19 ; metabolism ; Male ; Middle Aged ; Osteoporosis ; etiology ; Parathyroid Hormone ; metabolism ; Parathyroid Neoplasms ; complications ; metabolism ; pathology ; surgery ; Synaptophysin ; metabolism ; Thyroid Neoplasms ; metabolism ; pathology

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

Adult ; CD56 Antigen ; metabolism ; Carcinoma ; metabolism ; pathology ; surgery ; Carcinoma, Medullary ; pathology ; Carcinoma, Papillary ; metabolism ; pathology ; DNA-Binding Proteins ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Paraganglioma ; metabolism ; pathology ; Thyroid Neoplasms ; metabolism ; pathology ; surgery ; Thyroidectomy ; methods ; Transcription Factors ; Triglycerides ; metabolism

Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) and intraductal papillary mucinous neoplasm of the pancreas (IPMN-P) have striking similarities and are recognized as counterparts. However, simultaneous occurrence of IPMN-B and IPMN-P is extremely rare. A 66 year-old female presented with recurrent epigastric pain and fever. During the past 9 years, she had three clinical episodes related to intrahepatic duct stones and IPMN-P in the pancreas head and was managed by medical treatment. Laboratory test results at admission revealed leukocytosis (12,600/mm3) and elevated CA 19-9 level (1,200 U/mL). Imaging study demonstrated liver abscess in the Couinaud's segment 4, IPMN-B in the left lobe, and IPMN-P in the whole pancreas with suspicious malignant change. Liver abscess was drained preoperatively, followed by left lobectomy with bile duct resection and total pancreatectomy with splenectomy. On histologic examination, non-invasive intraductal papillary mucinous carcinoma arising from various degree of dysplastic mucosa of the liver and pancreas could be observed. However, there was no continuity between the hepatic and pancreatic lesions. This finding in our case supports the theory that double primary lesions are more likely explained by a diffuse IPMN leading to synchronous tumors arising from both biliary and pancreatic ducts rather than by a metastatic process. Herein we present a case of simultaneous IPMN of the bile duct and pancreas which was successfully treated by surgical management.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Adenocarcinoma, Papillary/*diagnosis/pathology/surgery ; Aged ; Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Bile Ducts, Intrahepatic/pathology ; CA-19-9 Antigen/analysis ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Female ; Hepatectomy ; Humans ; Leukocytosis/diagnosis ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the clinical application of carbon nanoparticles staining in cervical lymph node dissection on clinical neck lymph nodes the negative (cN0 period) thyroid papillary thyroid carcinoma (PTC). METHOD: This retrospective analysis comprised 100 papillary thyroid cancer patients who met inclusion criteria,and they were randomly divided into the nano-carbon group (50 cases) and control group (50 cases). They underwent lobectomy, subtotal thyroidectomy or total thyroidectomies and were given elective central compartment neck dissection (CCND). The number of detected lymph nodes in each group was summed, and pathological examination was conducted. The number of lymph nodes (dyedor not dyed) and the location of metastatic nodes were recorded separately. RESULT: In the nano-carbon group the average number of eliminated lymph nodes is significantly more than that of the control group(P<0.05). The metastasis lymph nodes in the nano-carbon group was higher than that in the control group(P<0.01). Among 100 cases, 2% had temporary vocal cord palsy, and 8% had temporary hypoparat hyroidism. No case of permanent vocal cord palsy or permanent hypocalcemia was observed. CONCLUSION The dyed lymph nodes can be easily identified and can be used as a guide for lymphnodes dissection in papillary thyroid carcinoma operation.
Carbon ; Carcinoma ; pathology ; surgery ; Carcinoma, Papillary ; Coloring Agents ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; diagnosis ; Nanoparticles ; Neck ; Neck Dissection ; Radiopharmaceuticals ; Retrospective Studies ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; Vocal Cord Paralysis

OBJECTIVETo study the clinicopathologic features of papillary tumor of the pineal region (PTPR).

METHODThree hundred and eighty six cases of pineal region and posterior third ventricle tumors, two newborn and two adult pineal glands were analyzed by HE, PAS and immunohistochemistry of 16 antibodies (EnVision method).

RESULTSFive cases of PTPR were diagnosed with mixed papillary features and densely cellular areas, and included one recurrent case. In the papillary areas, the vessels were lined by one or several layers of cuboidal/columnar cells; the vessel wall was hyalinized. In the densely cellular areas, sheets or nests of tumor cells were seen. The tumor cells of these five cases were immunoreactive to CK, CK8/18, synaptophysin, MAP2, nestin, S-100, and vimentin. Four cases were immunoreactive to NSE and CgA; and 2 cases were immunoreactive to NF. All five cases were negative for EMA, CK5/6, CEA, and NeuN. Ki-67 labeling index ranged from 1% to 6%.Three patients were alive, and the recurrent one died.

CONCLUSIONSPTPR occurs in patients with over a wide age range, from children to adults, and is more commonly found in male than female. PTPR is composed of both papillary and solid areas, characterized by epithelial cytology, and needs to be differentiated from ependymoma. PTPR may originate from the specialized ependymocytes of the subcommissural organ. The prognostic factors are early diagnosis, complete surgical resection and radiotherapy.

Adolescent ; Adult ; Brain Neoplasms ; diagnostic imaging ; metabolism ; pathology ; radiotherapy ; surgery ; Carcinoma, Papillary ; diagnostic imaging ; metabolism ; pathology ; radiotherapy ; surgery ; Child ; Diagnosis, Differential ; Ependymoma ; metabolism ; pathology ; Female ; Humans ; Immunohistochemistry ; Keratin-18 ; metabolism ; Keratin-8 ; metabolism ; Keratins ; metabolism ; Male ; Microtubule-Associated Proteins ; metabolism ; Nestin ; metabolism ; Pineal Gland ; Pinealoma ; metabolism ; pathology ; S100 Proteins ; metabolism ; Synaptophysin ; metabolism ; Tomography, X-Ray Computed ; Vimentin ; metabolism ; Young Adult

Adult ; CD56 Antigen ; metabolism ; Carcinoma, Papillary ; diagnosis ; metabolism ; pathology ; surgery ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; methods ; Female ; Humans ; Male ; Neprilysin ; metabolism ; Pancreatic Neoplasms ; diagnosis ; metabolism ; pathology ; surgery ; Receptors, Progesterone ; metabolism ; Vimentin ; metabolism ; Young Adult ; beta Catenin ; metabolism

OBJECTIVETo study the pathology, diagnosis and differential diagnosis of papillary carcinoma of the breast featuring expansile invasion.

METHODSMorphologic analysis and immunohistochemical study using MaxVision method were carried out in 25 cases of papillary carcinoma of the breast featuring expansile type of invasion.

RESULTSAll the 25 cases were female, and ranged from 26 to 84 years old in age with median of 69. The diameters of the neoplasms were from 1 cm to 5 cm, among which those of two cases were 4 cm and 5 cm respectively and the others were less than 2.5 cm. The tumor appeared solid and well-demarcated on gross examination. Histologically, the tumor was non-encapsulated. In some cases, the tumor tissue was separated by fibrous septa or intervening native breast tissue. The tumor was composed of arborizing papillae with fibrovascular cores, associated glandular fusion and cribriform pattern. The fibrovascular cores were covered by cuboidal to columnar cells. In 3 of the cases studied, focal transition with micropapillary ductal carcinoma-in-situ was demonstrated. The tumor cells showed mild or moderate degree of nuclear pleomorphism and contained amphophilic to eosinophilic cytoplasm. Mitotic figures were not frequently seen. One case displayed squamous metaplasia and 4 cases showed apocrine metaplasia. Dimorphic features were identified in 2 cases. The stromal tissue within the tumor was often scanty and sometimes sclerotic, associated with various degrees of inflammatory infiltrate and hemosiderin deposition. Immunohistochemical study for smooth muscle actin, p63, CD10 and CK5/6 showed negative staining in all of the 25 cases studied, including the 2 cases with dimorphic features. Seven cases had breast cancer marker study performed. Six cases were positive for estrogen receptor and progesterone receptor. HER2 oncoprotein was not over-expressed in 6 cases. Nine patients underwent axillary dissection and 2 of them showed axillary nodal metastasis.

CONCLUSIONSDiagnosis of papillary carcinoma of the breast is one of the most difficult areas in breast pathology. Demonstration of expansile type of invasion, when coupled with complex papillary fusion, cribriform pattern and absence of myoepithelial cells on immunohistochemistry, is helpful in arriving at a correct diagnosis.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; metabolism ; pathology ; surgery ; Carcinoma, Papillary ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Mastectomy, Modified Radical ; Middle Aged ; Mucin-1 ; metabolism ; Neoplasm Invasiveness ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism