Publications (11) View all
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Article: Sites of Metastases of Anaplastic Thyroid Carcinoma: Autopsy Findings in Forty Five Cases from a Single Institution.
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ABSTRACT: Background: Despite surgical treatment, chemotherapy and/or radiotherapy, the vast majority of patients with anaplastic thyroid carcinoma (ATC) have a dismal prognosis. Better knowledge of the frequency of metastases to different sites might help us to perform the appropriate diagnostic tests before treatment and during the course of the disease. The aim of this study was to determine the frequency of metastases from ATC in different sites as found at autopsy. Methods: Altogether, 205 patients were treated for ATC at our Institute during the years 1972 to 2008. Autopsy was performed in 45 cases (30 females, 15 males; median age 66 years). The relative frequencies of metastases in different sites were analyzed using descriptive statistics. Results: Altogether, 41 (= 91%) cases had metastases at autopsy. The most common sites of metastases were lungs (78%), intrathoracic region (58%) and neck lymph nodes (51%), pleura (29%), adrenal glands (24%), liver (20%), brain (18%), heart (18%) and retroperitoneal lymph nodes (18%). Less common sites of distant metastases were pericardium (13%), bones (13%), kidneys (13%), mesentery or peritoneum (13%), skin (9%), pancreas (4%), stomach (4%), diaphragm (4%), pituitary (2%), ovary (2%), jejunum (2%), axillary lymph nodes (2%) and gingival mucosa (2%). Distant and regional metastases were present in 23 cases, while only distant metastases were present in 18 cases. An extensive local infiltration of the primary tumor was found in 76% of the cases. The total number of the involved organs and lymph node basins were 123 and 58, respectively. The mean number of metastatic sites was 4.02 (± 2.75). Lung metastases were present in 34 of 38 (= 89%) of our patients who had distant metastases found at autopsy. Of these 34, 27 patients were known to have lung metastases when they were alive. Conclusion: Two or more metastatic sites were found at autopsy in 84% of cases. The most common metastatic sites are lungs, followed by the intrathoracic and neck lymph nodes.Thyroid: official journal of the American Thyroid Association 11/2012; · 2.60 Impact Factor -
Article: Neoadjuvant Chemotherapy in 16 Patients with Locally Advanced Papillary Thyroid Carcinoma.
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ABSTRACT: Background: It is believed that chemotherapy (ChT) is ineffective in papillary thyroid carcinoma (PTC). The aim of our retrospective chart review was to find out if neodjuvant ChT before thyroid surgery had any effect on the size of primary tumors in patients with PTC. Methods: The study included 16 patients (13 women, 3 men; median age 63.5 years) with PTC, who were treated with neoadjuvant ChT from 1988-2005. Poorly differentiated PTC, classical PTC, a follicular variant of PTC and a Hürthle cell variant of PTC were diagnosed in five, five, three and three cases, respectively. The mean tumor diameter was 9.67 cm. Seven patients had a pT4 tumor. Regional and distant metastases were detected in ten and seven patients, respectively. ChT consisted of vinblastine in eleven cases, vinblastine with adriamyin in two cases and other schedules in three cases. Four patients were also treated with preoperative external irradiation. Results: Altogether, 40 cycles of ChT were given. After ChT tumor size decreased in all 16 patients: by more than 50% in seven (= 44%) patients and by less than 50% in nine patients. R0, R1 and R2 resection was performed in two, ten and four cases, respectively. The median survival time of our patients was 88 months. Six patients are still alive, two died of causes not related to carcinoma, while eight patients died of PTC. Conclusions: Neoadjuvant ChT before thyroid surgery may be effective in patients with locally advanced PTC. After neoadjuvant ChT, in 44% of patients the tumor size decreased by more than 50%.Thyroid: official journal of the American Thyroid Association 09/2012; · 2.60 Impact Factor -
Article: International multicenter tool to predict the risk of four or more tumor-positive axillary lymph nodes in breast cancer patients with sentinel node macrometastases.
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ABSTRACT: Recently, many centers have omitted routine axillary lymph node dissection (ALND) after metastatic sentinel node biopsy in breast cancer due to a growing body of literature. However, existing guidelines of adjuvant treatment planning are strongly based on axillary nodal stage. In this study, we aim to develop a novel international multicenter predictive tool to estimate a patient-specific risk of having four or more tumor-positive axillary lymph nodes (ALN) in patients with macrometastatic sentinel node(s) (SN). A series of 675 patients with macrometastatic SN and completion ALND from five European centers were analyzed by logistic regression analysis. A multivariate predictive model was created and validated internally by 367 additional patients and then externally by 760 additional patients from eight different centers. All statistical tests were two-sided. Prevalence of four or more tumor-positive ALN in each center's series (P = 0.010), number of metastatic SNs (P < 0.0001), number of negative SNs (P = 0.003), histological size of the primary tumor (P = 0.020), and extra-capsular extension of SN metastasis (P < 0.0001) were included in the predictive model. The model's area under the receiver operating characteristics curve was 0.766 in the internal validation and 0.774 in external validation. Our novel international multicenter-based predictive tool reliably estimates the risk of four or more axillary metastases after identifying macrometastatic SN(s) in breast cancer. Our tool performs well in internal and external validation, but needs to be further validated in each center before application to clinical use.Breast Cancer Research and Treatment 04/2013; · 4.43 Impact Factor -
Article: Neoadjuvant chemotherapy in 29 patients with locally advanced follicular or Hürthle cell thyroid carcinoma: a phase 2 study.
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ABSTRACT: It is believed that chemotherapy (ChT) is ineffective in follicular thyroid carcinoma (FTC) and Hürthle cell thyroid carcinoma (HCTC). The aim of our retrospective study was to find out whether neodjuvant ChT before thyroid surgery had any effect on the size of primary tumor in patients with FTC or HCTC. The study included 29 patients (20 women, 9 men; mean age: 60.8 years) with FTC or HCTC who had T3 or T4 tumor and were treated with neoadjuvant ChT from 1979 to 2004. A mean tumor diameter was 9.3 cm. Extrathyroid growth of tumor was present in 15 patients. Regional and distant metastases were detected in 6 and 12 patients, respectively. With respect to the site of metastatic spread, the lung was involved in eight patients and the skeleton in five. ChT consisted of vinblastine in 19 cases, vinblastine with adriamycin in 5 cases, or other ChT regimens in 5 cases. Altogether, 67 cycles of ChT were given and tumor size decreased by >50% in 13 patients (=45%). ChT was effective in patients with FTC and HCTC in 47% and 43%, respectively. In the patients with and without distant metastases, the primary tumor size decreased by >50% in 17% and 65% (p=0.02), respectively. R0, R1, and R2 resection was performed in 15, 10, and 4 cases, respectively. Histopathology revealed that ChT (i.e., wide areas of tumor necrosis) was effective in seven patients (24%). The 5- and 10-year cause-specific survivals of the patients were 77% and 47%, while the 5- and 10-year disease-free intervals were 57% and 46%, respectively. Six patients are alive (median survival: 162 months), four of them have no evidence of disease, six patients died of other causes (median survival: 101 months), while 17 patients died of FTC or HCTC (median survival: 72 months). Among them, 16 died of distant metastases, while only one succumbed to locoregional recurrence and distant metastases. ChT before surgical procedure may be effective in order to decrease the tumor size in FTC or HCTC in 45% of patients.Thyroid: official journal of the American Thyroid Association 12/2011; 22(2):131-7. · 2.60 Impact Factor -
Article: Lobular breast carcinoma metastasis to a superficial plexiform schwannoma as the first evidence of an occult breast cancer.
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ABSTRACT: Tumor to tumor metastasis is a rare phenomenon, in which one, benign or malignant, tumor is involved by metastatic deposits from another. Most documented tumor to tumor metastases have been located intracranially, in which, in the majority of cases, either a breast or a lung carcinoma metastasized to a meningioma. Only 7 cases of metastases to schwannoma have so far been reported in the English literature, in 6 cases to an intracranial acoustic schwannoma and in a single case to a subcutaneous schwannoma. We present a case of dermal/subcutaneous plexiform schwannoma containing metastatic deposits of an occult lobular breast carcinoma, creating a unique schwannoma with epithelioid cells. Differential diagnosis of schwannoma with epithelioid cells includes malignant transformation of schwannoma and metastasis of a carcinoma or melanoma to schwannoma, epithelioid schwannoma, and schwannoma with glandular or pseudo glandular elements.The American Journal of dermatopathology 12/2011; 33(8):845-9. · 1.30 Impact Factor
