Anaplastic thymic carcinoma: a clinicopathologic and immunohistochemical study of 6 cases
ABSTRACT Primary thymic anaplastic ("undifferentiated") carcinoma is an unusual thymic neoplasm that, to date, has not been properly characterized. We present 6 such cases in an attempt to better define this entity. The patients were 5 women and 1 man with an age range from 42 to 72 years (mean, 62 years). None of the patients had any history or radiologic evidence of tumor elsewhere. All patients presented with symptoms related to their anterior mediastinal masses: shortness of breath, chest pain, and cough. Histologically, the lesions were characterized by infiltrative tumors with marked cytologic atypia, bizarre tumor giant cells, and atypical mitoses. None of the neoplasms showed areas of other well-defined types of thymic carcinoma. Immunohistochemically, all tumors showed positive staining for pancytokeratin, 40% expressed Pax8, and none reacted with thyroid transcription factor 1 or β-human chorionic gonadotropin. Follow-up available for 4 patients showed that 3 patients had died 14, 22, and 63 months after diagnosis, whereas 1 patient is alive 4 months after diagnosis. Two patients were lost to follow-up. Anaplastic thymic carcinoma is a distinct morphological type of thymic carcinoma with an aggressive clinical course, which needs to be included in the differential diagnosis of tumors displaying giant cells in the anterior mediastinum.
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ABSTRACT: Background: Malignant serous cavity effusion caused by primary thyroid cancer is extremely rare in routine clinical practice. Therefore, it is often not included in the differential diagnostic workup of patients presenting with positive effusion cytology. Methods: The clinical features were reviewed for 6 patients seen at our institution over the last 26 years for malignant effusion resulting from metastatic thyroid cancer. The cytomorphology from 4 of these cases was also reviewed. Results: All of the patients found in this study presented with malignant pleural effusion - other serous cavity effusions resulting from metastatic thyroid carcinoma were not seen. These comprised 0.25% of all patients with a known history of thyroid carcinoma and 0.67% of all malignant pleural effusions. One patient had a history of bone metastases, but all the others had no pathological evidence of distant metastatic disease prior to the pleural effusion. Conclusions: Malignant pleural effusion rarely results from a thyroid carcinoma after some latency. The diagnosis requires immunohistochemical staining as well as the pertinent clinical context.Acta cytologica 01/2013; 57(2):177-83. DOI:10.1159/000345696 · 1.56 Impact Factor
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ABSTRACT: OBJECTIVE. It is difficult to diagnose anaplastic thyroid carcinoma (ATC) on fine needle aspiration (FNA) samples because, given the loss of morphological and immunophenotypical follicular thyroid features, its cytology resembles those of other undifferentiated neoplasms. Recent studies showed that immunostaining for PAX8, a transcription factor expressed in normal thyroid, is effective in diagnosing ATC on histology. The aim of this study was to evaluate whether PAX8 could identify ATC also on cytology. DESIGN AND METHODS. We selected and PAX8-immunostained three undifferentiated FNAs previously diagnosed as suspected ATCs, whose cell block had been negative for TGB and TTF1 expression. Matched histological samples, available in two cases, were also processed for PAX8. RESULTS. All three FNAs cases were PAX8-positive. Two samples that had an epithelioid pattern showed a diffuse, intense nuclear signal. The third sample, which had a spindle-cell pattern, showed less intense and more patchy staining. Matched histology yielded overlapping results. CONCLUSIONS. PAX8 immunocytochemistry can help the cytopathologist to diagnose ATC.European Journal of Endocrinology 06/2013; DOI:10.1530/EJE-13-0150 · 3.69 Impact Factor
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ABSTRACT: The clinicopathologic and immunohistochemical features of 65 primary thymic carcinomas are reported (43 men and 22 women; 19-81 years old). Thymectomy was performed in all cases. Masaoka staging for 53 patients showed 3 patients in stage I, 14 in stage II, 17 in stage III, and 19 in stage IV. Histologic studies revealed 9 carcinoma subtypes. Immunohistochemically, the tumors showed high rates of expression for cytokeratin, Pax8, and FoxN1. Follow-up for 62 patients revealed that 36 patients were alive (mean follow-up, 51.1 months) and 26 had died (mean survival, 47.5 months). The 3- and 5-year overall survival rates were 76.6% and 65.7%, respectively. Our findings suggest that thymic carcinomas may behave less aggressively than commonly believed. Lymph node status and tumor size seem to be important prognostic factors. The Masaoka staging system does not seem to reliably predict outcome.American Journal of Clinical Pathology 07/2012; 138(1):103-14. DOI:10.1309/AJCP88FZTWANLRCB · 2.88 Impact Factor