PURPOSE: To compare the cytological results of ultrasound-guided fine-needle aspiration (US-FNA) cytology of thyroid nodules to sonographic findings and determine whether US findings are helpful in the interpretation of cytological results. MATERIALS AND METHODS: Among the thyroid nodules that underwent US-FNA cytology, we included the 819 nodules which had a conclusive diagnosis. Final diagnosis was based on pathology from surgery, repeated FNA cytology or follow-up of more than one year. Cytological results were divided into five groups: benign, indeterminate (follicular or Hurthle cell neoplasm), suspicious for malignancy, malignant, and inadequate. US findings were categorized as benign or suspicious. Cytological results and US categories were analyzed. RESULTS: Final diagnosis was concluded upon in 819 nodules based on pathology (n=311), repeated FNA cytology (n=204) and follow-up (n=304), of which 634 were benign and 185 were malignant. There were 560 benign nodules, 141 malignant nodules, 49 nodules with inadequate results, 21 with indeterminate results, and 48 that were suspicious for malignancy. The positive and negative predictive values of the US categories were 59.1% and 97.0%, and those of the cytological results were 93.7% and 98.9%. The US categories were significantly correlated with final diagnosis in the benign (p=0.014) and suspicious for malignancy (p<0.001) cytological result groups, but not in the inadequate and indeterminate cytological results groups. The false positive and negative rates of cytological results were 1.9% and 3.2%. CONCLUSION: Sonographic findings can be useful when used alongside cytological results, especially in nodules with cytological results that are benign or suspicious for malignancy.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle ; Child ; Cytodiagnosis ; False Negative Reactions ; False Positive Reactions ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Neoplasms/diagnosis/pathology/ultrasonography ; Thyroid Nodule/*diagnosis/pathology/ultrasonography ; Young Adult

The clinical behaviors and treatment outcomes of thyroid carcinomas in patients with Graves' disease is a matter of controversy. This study aimed to identify the clinicopathologic features, treatment outcome, and the indicators for predicting recurrence, and to suggest the optimal extent of surgery in these patients. We retrospectively analyzed data of 58 patients who underwent surgical treatment for differentiated thyroid cancer and concurrent Graves' disease. The follow-up period ranged from 23 to 260 months (mean+/-standard devuation, 116.8+/-54.0). In our series, the mean age was 40.8+/-12.7 yr (range, 15-70), with a male-to-female ratio of 1: 6.25. The mean tumor size was 13+/-9 mm (range, 3-62). The surgical methods included 19 cases of total thyroidectomy, 38 cases of subtotal thyroidectomy, and 1 case of completion total thyroidectomy. Locoregional recurrence occurred in four patients (6.9%). The 10-yr overall survival and disease-free survival of patients were 95.8% and 91.1%, respectively. Age over 45 yr (p=0.031), tumor size over 10 mm (p=0.049), multiplicity (p=0.007), extracapsular invasion (p=0.021), and clinical cancer (p=0.035) were significantly more prevalent in patients with locoregional recurrence than in those without recurrence. We recommend that Graves' disease patients should undergo regular ultrasonography screening for early detection of thyroid carcinoma. We also suggest that the choice of extent of surgery should depend on the diagnostic timing (clinical or incidental) and factors for predicting recurrence.
Adult ; Comorbidity ; Disease-Free Survival ; Female ; Graves Disease/*complications/*therapy ; Humans ; Male ; Middle Aged ; Recurrence ; Thyroid Neoplasms/*complications/*therapy ; Time Factors ; Treatment Outcome

PURPOSE: Subacute thyroiditis (SAT) is an uncommon, self-lemiting inflammatory disorder. If clinicians cannot rule out thyroid cancer in SAT patients with a thyroid nodule, surgical management can be considered. This study was performed to review the clinical characteristics of patients who were treated surgically for SAT presenting with thyroid nodule. METHODS: We retrospectively reviewed the clinical features of 14 cases who underwent an operation for SAT with a thyroid nodule between January 1986 and May 2006 at our institution. RESULTS: There were 3 male and 11 female patients, with a mean age of 47 years. All patients underwent surgical management prior to 1998. Twelve patients had thyroidal pain, 6 had viral prodromal symptoms, and 5 had hyperthyroidisms. Preoperative erythrocyte sedimentation rates (ESRs) (n=4) were elevated in 3 patients. Decreased uptake of radioiodine was reported in all 6 patients for whom scans were performed (n=6). Fine needle aspiration biopsy (FNAB) was performed in 4. In this study, the operative indications were clinically indeterminate thyroid nodule (n=14); lobectomy in 8, lobectomy with partial thyroidectomy in 2, lobectomy with near total thyroidectomy in 2, and bilateral total thyroidectomy in 2. Hoarseness occurred in one patient. CONCLUSION: SAT is usually managed clinically, but patients presenting with an indeterminate thyroid nodule will require surgical management even though they may have more benign characteristics. Most surgeons have to wait for the results of frozen biopsy because limited resectioning can be performed if the results are benign.
Biopsy ; Biopsy, Fine-Needle ; Blood Sedimentation ; Female ; Hoarseness ; Humans ; Male ; Prodromal Symptoms ; Retrospective Studies ; Surgeons ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis, Subacute*

Cavernous hemangioma is a benign congenital vascular malformation that can affect any part of the body. However, primary hemangioma of the thyroid gland is extremely rare with only six cases reported in the literature. We report here on a case of a cavernous hemangioma of the thyroid gland in a 66-year-old man. Magnetic resonance imaging (MRI) showed a huge exophytic mass measuring 17 cm, which had replaced the left lobe of the thyroid. The histologic examination of the surgical specimen revealed a huge cavernous hemangioma.
Aged ; Hemangioma ; Hemangioma, Cavernous* ; Humans ; Magnetic Resonance Imaging ; Thyroid Gland* ; Vascular Malformations

Recently, the rearrangement of RET proto-oncogene has been reported to be the most common genetic change in papillary thyroid carcinoma (PTC). However, its prevalence has been reported variably and its relation to clinical outcome has been controversial. The characteristic nuclear features of PTC usually render the diagnosis, but problem arises with equivocal cytologic features that are present focally. Although there remains some controversy, CK19 has been reported to be a useful ancillary tool for diagnosis of PTC. To evaluate the expression rate of RET/PTC rearrangement and CK19 in PTCs in a Korean population, we studied 115 papillary thyroid carcinomas in 3 mm-core tissue microarray based immunohistochemical analysis. The prevalence of Ret protein expression was 62.6% and the CK19 immunoreactivity was 80.9%. There was no statistically significant asso-ciation between the Ret positivity and CK19 immunoreactivity, although the percent agreement of the two was relatively high. The clinicopathological variables did not correlate with the expression of Ret. In conclusion, the prevalence of Ret protein expression and its clinicopathological implications in a Korean population are not much different from those reported in previous studies. However, its detection via immunohistochemistry can be a useful diagnostic tool for diagnosing papillary thyroid carcinoma in conjunction with CK19.
Adenocarcinoma, Papillary/*metabolism ; Adult ; Carcinoma/pathology ; Cell Line, Tumor ; Cytoplasm/metabolism ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Immunohistochemistry ; Keratin/*biosynthesis ; Korea ; Lymphatic Metastasis ; Male ; Middle Aged ; Oligonucleotide Array Sequence Analysis ; Oncogene Proteins/*biosynthesis ; Receptor Protein-Tyrosine Kinases/*biosynthesis ; Thyroid Neoplasms/*metabolism/pathology

Forgotten mediastinal goiter is an extremely rare disease. It is most often the consequence of the incomplete removal of a ‘ plunging’ goiter, but it can sometimes be attributed to a concomitant, unrecongnized primary mediastinal goiter which is not connected to the thyroid. A primary mediastinal goiter(autonomous intrathoracic goiter) essentially caused by an abnormal embryonic development of the thyroid gland and a thyroid gland formation located in the thorax or the mediastinum. The differential diagnosis with ordinary recurrence was based on the absence of parenchymatous or vascular connections with the cervical thyroid gland. It is fed by local intrathoracic vessels and observed in the absence of previous thyroidectomy. Nevertheless, for primary mediastinal goiter, sternum-splitting incision will be required in most cases as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision. In this study we report a case of forgotten mediastinal goiter and review the various diagnostic and therapeutic problems posed by the condition. A number of possible solutions that can be implemented for this diasease are identified.
Diagnosis, Differential ; Embryonic Development ; Female ; Goiter* ; Hemorrhage ; Mediastinum ; Pregnancy ; Rare Diseases ; Recurrence ; Thorax ; Thyroid Gland ; Thyroidectomy

Cribriform-morular variant (CMV) is a rare histologic subtype of papillary thyroid carcinoma (PTC). Patients with familial adenomatous polyposis (FAP) could be associated with several comorbid diseases including thyroid cancer. Most thyroid cancers in them are PTCs, but infrequently CMV types can occur. The FAP concomitant CMV-PTCs are found predominantly in young women and reveals lower recurrence rate. Moreover, this variant shows circumscribed morphology and rarely metastasizes to node. Because the incidence of thyroid carcinoma is higher than that in general population, comprehensive evaluation of thyroid gland should be performed for the patients with FAP. Because thyroid cancer could be first manifestation of FAP, colonic screening should be considered in CMV-PTC patient. We report two cases of CMV-PTCs concurrent with FAP.
Adenomatous Polyposis Coli* ; Carcinoma, Papillary* ; Colon ; Female ; Humans ; Incidence ; Mass Screening ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms

Most patients with thyroid cancer have well differentiated tumors that usually respond to conventional therapy including total or near total thyroidectomy, radioiodine ablation and TSH suppression. About 10% of patients, however, have aggressive cancers as a consequence of de-differentiation. During de-differentiation, thyroid cancers not only show more mitosis, fibrosis, and altered cell structure, they also lose thyroid-specific functions (iodine uptake, TSH receptor expression, and thyroglobulin production). These poorly differentiated or undifferentiated tumors mostly fail to take up radioiodine and are responsible for most deaths from thyroid cancer. New therapies need to be developed for patients with these types of tumors. Among the most promising antineoplastic therapies for these poorly differentiated and undifferentiated thyroid cancers are the histone deacetylase inhibitors, the PPAR-gamma agonist and retinoic acids. These drugs have therapeutic effects for thyroid cancers in inhibiting growth and inducing apoptosis and redifferentiation, in vivo and in vitro studies. And, clinical trials in patients with refractory thyroid cancers have been initiated. Further laboratory investigation of these drugs is necessary to understand molecular mechanisms and demonstrate therapeutic efficacy for thyroid cancers.
Apoptosis ; Fibrosis ; Histone Deacetylase Inhibitors* ; Histone Deacetylases* ; Histones* ; Humans ; In Vitro Techniques ; Mitosis ; Receptors, Thyrotropin ; Therapeutic Uses ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Tretinoin*

Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasms and has a grave prognosis. This study gives an update on our experience with this unusual neoplasm, with specific focus on the response to various treatment modalities. Forty-seven patients with histologically proven ATCs were enrolled (19 men, 28 women; mean age, 62.8 years). This number represents 1.5% among a total of 3, 088 thyroid cancers treated between 1977 and 2002. The mean tumor diameter was 8.8 cm, and 22 patients had distant metastasis. Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted could be classified into 5 groups: Group 1, biopsy only; Group 2, biopsy and chemoradiotherapy; Group 3, debulking only; Goup 4, debulking and chemoradiotherapy; Group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. The mean survival was 4.3 months (range, 1.0-21 months). The mean survival based on treatment modalities were as follows: Group 1 (n = 10), 2.1 months, Group 2 (n = 8) ; 3.6 months; Group 3 (n = 7), 3.0 months; Group 4 (n = 14), 3.5 months, Group 5 (n = 8), 9.4 months. There was no significant difference in survival time between the various types of treatment modalities. Even though a small improvement in survival was observed with complete excision and aggressive multimodality therapy, nearly all ATCs remain unresponsive to ongoing treatment modalities and as such, present a therapeutic dilemma. A more effective treatment regimen should be sought in order to improve survival.
Treatment Outcome ; Thyroid Neoplasms/mortality/surgery/*therapy ; Survival Analysis ; Radiotherapy, Adjuvant ; Neoplasm Metastasis ; Middle Aged ; Male ; Humans ; Female ; Combined Modality Therapy ; Chemotherapy, Adjuvant ; Carcinoma/mortality/surgery/*therapy ; Aged, 80 and over ; Aged ; Adult

PURPOSE: Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasm, with a grave prognosis. This study updates our experience with this unusual neoplasm with specific focus on the response to various treatment modalities. METHODS: Forty-seven patients with histologically proven ATC were enrolled (19 men, 28 women; mean age, 62.8 years). This group represented 1.5% of the 3, 088 thyroid cancers treated between 1977 to 2002. The mean diameter of tumor was 8.8 cm (range, 2.0~20.0 cm), and 22 patients had distant metastasis (10 in the lung, 8 lung and bone, 1 brain, 1 mediastinum, and 2 lung and mediastinum). Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted were classified into 5 groups. Group 1, biopsy only; group 2, biopsy and chemoradiotherapy; group 3, debulking only; group 4 debulking and chemoradiotherapy; and group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. RESULTS: The mean survival was 4.3 months (range, 1.0~21 months). The mean survival bases of treatment modalities were as follows: group 1 (n=10), 2.1 months (range 1.0~6.0); group 2 (n=8), 3.6 months (range, 2.0~7.0 months); group 3 (n=7), 3.0 months (range, 1.0~11.0 months); group 4 (n=14), 3.5 months (range, 2.0~9.0 months), group 5 (n=8), 9.4 months (range 5.0~21.0 months). CONCLUSION: Even though a small improvement of survival in response was observed with complete excision and aggressive multimodality therapy, nearly all ATC remains ineffective to ongoing treatment modalities and continue to present a therapeutic dilemma. A more effective treatment regimen should be sought for improving the survival rate.
Biopsy ; Brain ; Chemoradiotherapy ; Diagnosis ; Female ; Humans ; Lung ; Male ; Mediastinum ; Neoplasm Metastasis ; Prognosis ; Survival Rate ; Thyroid Gland* ; Thyroid Neoplasms* ; Treatment Outcome