Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma with Multiple Metastases and Elevated Serum Carcinoembryonic Antigen Level.
ABSTRACT Background: Diffuse sclerosing variant of papillary thyroid carcinoma (DSPC) is a rare variant of papillary thyroid carcinoma (PTC). We report a 61-year-old female of DSPC whose course was complicated by multiple metastases and an elevated serum carcinoembryonic antigen (CEA) level. Summary: The patient presented with upper back pain. X-ray showed an osteolytic lesion of 6th cervical spinous process. She had a hard, non-movable mass with fixed enlarged lymph nodes over right neck. Fine needle aspiration cytology revealed PTC with lymph nodes metastasis. Positron emission tomography demonstrated multiple brain, bone, liver and lung metastases. However, the patient had an elevated serum CEA level. She underwent a total thyroidectomy and 200 mCi radioactive I-131 therapy. The pathological findings were diffuse sclerosing variant of PTC with capsular and lymph vessel invasion. A double staining of tumor specimen appeared concomitantly positive for CEA and thyroglobulin. Conclusions: To our knowledge, DSPC with an elevated CEA level is extremely rare.
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ABSTRACT: A review of 92 consecutive cases of papillary thyroid carcinoma diagnosed at The Methodist Hospital revealed 11 tall cell variant (TCV) cases in nine women and two men. There was a greater average age and larger tumor diameter of TCV cases compared with papillary thyroid carcinoma of the usual type (UPTC), but these differences were not statistically significant. Extrathyroidal extension of tumor was noted in nine of 11 TCV cases and was intraoperatively evident in five cases. The presence of extrathyroidal extension represented a statistically significant difference between TCV and UPTC (p = 0.0001) in a multivariate stepwise logistic regression analysis, with controls for variables of age, sex, tumor size, and lymph node metastases. In 11 TCV patients, tumor recurrence was present in two cases, and there was one tumor-associated death with 1 to 4 years of follow-up. Immunohistochemical stains for thyroglobulin, vimentin, keratins, and Leu-7 were positive in all TCV cases and in 16 of 16 UPTC. Immunoreactivity with antibodies to Leu M1 antigen, a myelomonocytic marker included in cluster designation group (CD 15), which is present in many adenocarcinomas, was present diffusely in all TCV, in contrast to UPTC (with sparse immunostaining in only one of 16 cases). Immunoreactivity with antibodies to ZC-23, an anti-carcinoembryonic antigen (CEA) monoclonal antibody with cross-reactivity to nonspecific cross-reacting antigen and biliary glycoprotein antigen, was present in all TCV but was not present in UPTC. COL-1, a CEA-specific monoclonal antibody, was nonimmunoreactive with all TCV and UPTC cases. Epithelial membrane antigen (EMA) was present in all TCV but was also present focally in eight of 16 UPTC, sometimes in a membranous pattern in epithelium surrounding cystic or hemorrhagic spaces. Strong immunoreactivity with antibodies to Leu M1 and EMA in papillary carcinomas of the thyroid has been associated with advanced stages of disease and tumor-associated mortality. The pattern of immunoreactivity in TCV is dissimilar to that in UPTC and is supportive evidence that TCV is a neoplasm that is distinct from papillary thyroid carcinoma of the usual type.American Journal of Surgical Pathology 09/1996; 20(8):964-74. · 4.87 Impact Factor
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ABSTRACT: An accelerated rate of glucose metabolism mediated by overexpression of key regulatory glycolytic enzymes and glucose transporters is among the most characteristic biochemical marker of malignant transformed cells. In thyroid neoplasms, however, an increased uptake of glucose [measured by 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) and positron emission tomography (PET)] seems to be restricted to more aggressive and high-grade tumors, whereas tumors with favorable prognosis demonstrate no significant tracer uptake. We therefore studied the expression of glucose transporters in thyroid carcinomas with different grades of malignancy. Sections of formalin-fixed and paraffin-embedded tissue obtained from 45 patients with thyroid cancer (5 anaplastic, 20 papillary and 20 follicular tumors) were investigated. Polyclonal rabbit antiglucose transporter antibodies, reactive with glucose transporters 1-5 (GLUT1-5), were used after heat pretreatment of the sections. Staining was performed by the avidin-biotin conjugate immunoperoxidase reaction and evaluated semiquantitatively. Expression of GLUT1 transporter on the cell membrane was closely related to the grade of malignancy in thyroid neoplasms (Fisher exact test p < 0.05). All anaplastic tumors showed a high level of GLUT1 expression in the cytoplasm and on the cell membrane. Positive membranous staining in differentiated tumors was detected predominantly in neoplasms with unfavorable prognosis, e.g., in widely invasive follicular or metastatic tumors, whereas low or no immunoreactivity could be seen in well-differentiated tumors or in normal thyroid epithelium. These data indicate that overexpression of GLUT1 on the cell membrane of thyroid neoplasms is closely related to tumors demonstrating a more aggressive biological behavior. Therefore, determination of GLUT1 expression in thyroid cancer tissue may be a prognostic marker, and FDG-PET may be a helpful technique in identifying patients at a higher risk.Thyroid 09/2002; 12(9):747-54. · 3.54 Impact Factor
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ABSTRACT: Diffuse sclerosing variant (DSV) is a rare variant of papillary thyroid carcinoma (PTC), and the features of this carcinoma have not been fully characterized. The aim of this study was to analyze the clinicopathologic features of a large cohort of patients with this disease. We reclassified primary thyroid carcinomas treated in a 35-year study period and studied the clinicopathologic features and outcomes of DSV of PTC in comparison with classic PTC. Fifteen patients (2 men and 13 women) with DSV of PTC were identified who had surgical resection of the thyroid. Fine-needle aspiration biopsy diagnosed 83% (10 of 12) of the tumors. Compared with classic PTC, patients with DSV presented at a younger age (mean age, 29 vs. 46 years; P = .0001), had larger tumors (mean diameter, 3.6 vs. 2.2 cm; P = .002), and had a higher incidence of cervical nodal metastases (80% vs. 43%; P = .006). Ten patients had received postoperative iodine 131 ablation, and four had also received external-beam irradiation. Distant metastases were detected in two patients (one in lung and one in brain). One third (5 of 15) of the patients developed disease recurrence. Lymph node recurrence was detected in one patient 12 years after the initial operation. Over a median follow-up period of 10.7 years, one patient with an initial incomplete excision died of the carcinoma. The overall disease-specific survival rate was 93%. DSV of PTC had distinctive clinicopathologic features and a high incidence of recurrence after operation but had a prognosis similar to that of classic PTC.Annals of Surgical Oncology 03/2006; 13(2):176-81. · 4.12 Impact Factor