Cases reported "Thyroid Neoplasms"

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1/919. A Val 677 activating mutation of the thyrotropin receptor in a Hurthle cell thyroid carcinoma associated with thyrotoxicosis.

    Thyroid nodules presenting as hot at 131I-scintigraphy are usually benign follicular adenomas. We report a 42-year-old female patient with an autonomously functioning Hurthle cell thyroid carcinoma causing thyrotoxicosis. Genetic analysis of her thyroid tumoral dna revealed a heterozygotic activating mutation of the thyrotropin receptor (TSHR) gene that was located downstream to all of the other genetic alterations currently identified, and is due to a base substitution at codon 677 (normal cytosine replaced by guanine, CTG for GTG causing leucine substitution by valine in the seventh transmembrane domain of the receptor). This mutation was detected in the tumor, but not in the leucocytes from the same patient. The Val 677-TSHR mutant showed constitutive activity, in terms of cyclic adenosine monophosphate (cAMP) production, when permanently transfected in Chinese hamster ovary (CHO) cells. Gsp and ras oncogenes and the p53 tumor suppressor gene were not present in the Hurthle cell cancer. The TSHR mutation in this Hurthle cell carcinoma may be responsible for maintaining differentiated thyroid function and hyperthyroidism.
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keywords = cancer
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2/919. Hurthle cell carcinoma of the thyroid gland with extensive tumor necrosis: a case report.

    Hurthle cell neoplasm of the thyroid gland is rarely associated with tumor necrosis. We report a case of Hurthle cell carcinoma of the thyroid gland with extensive necrosis. An 82-year-old man had had a right neck mass for more than 10 years. Approximately two to three weeks before he was hospitalized, this neck mass became progressively enlarged. An 131I scan could not demonstrate the right lobe of the thyroid gland, while the contralateral lobe was unremarkable. A 99mTc-sestamibi scan showed increased uptake on the lesion side. Fine needle aspiration cytology showed necrosis with macrophages in the initial aspirate, and the secondary aspirate appeared suspicious for a Hurthle cell tumor. The patient had a total thyroidectomy, and the pathology proved to be Hurthle cell carcinoma with tumor necrosis.
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ranking = 2.1435479754819
keywords = neoplasm
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3/919. False-positive result of a total-body scan caused by benign thyroidal tissue after I-131 ablation.

    This case report illustrates a false-positive result of an I-131 total-body scan caused by abnormal, noncancerous thyroid tissue. A 39-year-old woman underwent an open biopsy and thyroidectomy for a papillary thyroid carcinoma. She was treated by ablation with 150.8 mCi I-131. A follow-up total-body scan revealed a solitary focus of increased activity near the midline at the upper border of the larynx that was subsequently excised. Histologic analysis indicated a fragment of thyroid tissue with chronic inflammation, fibrosis, and squamous metaplasia. No evidence of thyroid carcinoma was present. Hypofunctioning or nonfunctioning residual tissue within the thyroglossal duct may have been suppressed under euthyroid conditions, protecting it from ablation. This tissue may have become stimulated by the high thyroid-stimulating hormone levels, accumulating I-131 and producing a false-positive result of the scan.
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keywords = cancer
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4/919. Tall cell variant of papillary thyroid carcinoma with foci of columnar cell component.

    We report a case of the tall call variant of papillary thyroid carcinoma with foci of columnar cell component in a 67-year-old Japanese man. Tall cell variant occupied more than 70% of the tumour, and columnar cell component was of two types in representative sections. One showed striking stratification of nuclei with scanty cytoplasm, and the other appeared clear. Characteristic nuclear features of papillary carcinoma were also observed in the area of the tall cell variant. The patient died of the thyroid cancer with aspiration pneumonia 10 years and 6 months after operation. Although autopsy was not performed, metastatic lymph nodes of the neck removed during life also showed papillary carcinoma with both tall cell and columnar cell components. Our case indicates that tall cell and columnar cell variants may coexist in the same tumour although the pathogenesis remains unclear.
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5/919. Tall cell variant of papillary thyroid cancer.

    Papillary histologic type is the most common form of thyroid carcinoma amounting to 85% cases. This pathology presents a rather good prognosis, but a few years ago, new subtypes have been described. Some of these variants show a fairly good prognosis i.e follicular, macropapillary, encapsulated while others appear to have a decidedly worse one, columnar cells, diffused sclerosing, or even to be clearly malignant as in the case of the tall cell variant. The authors report a case treated by a combined surgical and radiometabolic therapy and evidence the main characteristics of this rare and underestimated neoplasia.
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keywords = cancer
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6/919. Normal thyroid pathology in patients undergoing thyroidectomy for finding a RETgene germline mutation: a report of three cases and review of the literature.

    Genetic screening for germline RET proto-oncogene mutation in hereditary medullary thyroid cancer (MTC) is accurate and allows for preventive total thyroidectomy to be performed early in patients who are gene carriers. We report 3 children who underwent preventive total thyroidectomy based on the finding of a RETgene germline mutation, but who had no evidence of MTC or C-cell hyperplasia on permanent histology, even after calcitonin immunostaining. review of the English literature of patients undergoing preventive thyroidectomy for a positive RETgene germline mutation, shows that 3.4% of these patients (a total of 209 patients) had normal thyroid glands. Also, 8.6% of patients undergoing preventive total thyroidectomy with prophylactic central neck node dissection had cervical node metastases. We conclude that preventive thyroidectomy in patients screened early for germline RETgene mutation allows for earlier diagnosis and treatment of patients, sometimes even before any hyperplasia or neoplasia can be demonstrated because cervical node metastases can occur early and be demonstrated even with small tumors (< 1 cm), we recommend prophylactic central neck node dissection at the time of preventive thyroidectomy.
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keywords = cancer
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7/919. Severe thyrotoxicosis due to hyperfunctioning liver metastasis from follicular carcinoma: treatment with (131)I and interstitial laser ablation.

    liver metastases from differentiated thyroid tumors are unusual clinical findings, and are only rarely hyperfunctioning. We report a case of thyrotoxicosis caused by a huge and surgically unresectable liver metastasis from follicular thyroid cancer, unresponsive to treatment with large doses of thionamides. To avoid the hazardous side effects of (131)I treatment in a severely thyrotoxic patient, a preliminary debulking of the liver mass was performed by means of percutaneous interstitial laser photocoagulation. Three treatments (total energy delivery: 7200 J) were performed under ultrasound guidance, with no serious complications, during a 2-week period. One month later, serum thyroid hormones had decreased, general condition was improved, and magnetic resonance evaluation revealed large and well-defined areas of necrosis of metastatic tissue. During the following 10 months, the patient underwent 3 radioiodine treatments. Eighteen months after diagnosis, thyroid hormones were within normal levels, liver mass decreased, and the clinical condition markedly improved. The combination of percutaneous interstitial laser photocoagulation treatment and radioiodine therapy made possible the effective management of a hyperfunctioning and surgically untreatable liver metastasis from thyroid follicular carcinoma, avoiding the side effects of (131)I therapy in a thyrotoxic patient and increasing the effectiveness of radioiodine-induced neoplastic tissue ablation.
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keywords = cancer
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8/919. Primary T-cell lymphoma of the thyroid.

    BACKGROUND: The routine use of immunocytochemical analysis has led to the recognition that many thyroid neoplasms previously diagnosed as anaplastic or small cell carcinomas are actually lymphomas of the thyroid. The great majority are B-cell lymphomas which can be associated with Hashimoto's thyroiditis. In spite of this, thyroid lymphomas are still not commonly recognized as a significant part of thyroid differential diagnosis. methods: A rare case of a primary T-cell lymphoma of the thyroid gland is presented along with general clinical history and physical findings which should make the practitioner suspicious of a thyroid lymphoma. The usefulness of radiology scans and fine-needle aspiration are discussed. RESULTS: Both prognosis and treatment options are very different for thyroid lymphomas and anaplastic carcinoma. CONCLUSIONS: cyclophosphamide/adriamycin/vincristine/prednisolone chemotherapy/radiotherapy regimens have proven to be very effective for most thyroid lymphomas.
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ranking = 2.1435479754819
keywords = neoplasm
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9/919. Possible branchiogenic carcinoma coinciding with metastatic papillary thyroid carcinoma.

    We report the discovery of a cystic lesion of flat lining epithelium with areas of squamous carcinoma, associated with metastatic cervical nodes of a papillary thyroid cancer, and discuss the diagnostic possibilities.
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10/919. Occult sclerosing carcinoma of the thyroid.

    A case of occult sclerosing thyroid carcinoma is reported. The primary requirement for diagnosis is that the cancer is less than 1.5 cm in diameter. In addition, a fibrosing component with varying degrees of sclerosis is present. Lymph node metastases are frequent and may appear as benign thyroid follicles. Occasional direct invasion or vascular invasion may occur. Distant metastases were not reported in the series reviewed. Adequate therapy would seem to be total thyroidectomy of the involved lobe and radical subtotal thyroidectomy of the opposite lobe with excision of all enlarged or involved lymph nodes.
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