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Masanori Yamazaki,
Shin-Ichi Suzuki,
Shinji Kosugi,
Takahiro Okamoto,
Shinya Uchino,
Akihiro Miya,
Tsuneo Imai,
Hiroshi Kaji,
Izumi Komoto,
Daishu Miura,
Masanobu Yamada, Takashi Uruno,
Kiyomi Horiuchi,
Ai Sato,
Akira Miyauchi,
Masayuki Imamura,
Akihiro Sakurai
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ABSTRACT: The morbidity and mortality of individuals with multiple endocrine neoplasia type 1 (MEN1) can be reduced by early diagnosis of MEN1 and related endocrine tumors. To find factors contributing to early diagnosis, we collected clinical information on MEN1 patients through a MEN study group, "MEN Consortium of Japan" and analyzed the time of initial symptom-dependent detection of parathyroid tumors, gastro-entero-pancreatic neuroendocrine tumors (GEPNETs) and pituitary tumors, and that of tumor detection-dependent MEN1 diagnosis in 560 patients. Main tumors were identified up to 7.0 years after symptoms appeared and there was no difference in age at the diagnosis of GEPNETs alone between probands and family members. In patients with typical symptoms (peptic ulcers, urolithiasis, fasting hypoglycemia, bone fracture/loss and amenorrhea), the mean interval between symptom manifestation and tumor detection was extended up to 9.6 years. In particular, 21.7% (5/23) of patients with amenorrhea were diagnosed with pituitary tumors in under one year. In patients with peptic ulcers (from parathyroid tumors or GEPNETs) and urolithiasis (from parathyroid tumors), the interval was positively correlated with age at tumor detection. The interval between tumor detection and MEN1 diagnosis was also prolonged to approximately four years in patients with fasting hypoglycemia (from GEPNETs) and amenorrhea. A substantial delay in the diagnosis of symptom-related tumors and subsequent MEN1 and inadequate screening of GEPNETs in family members were indicated. A greater understanding of MEN1 may assist medical practitioners to make earlier diagnoses, to share patients' medical information and to give family members sufficient disease information.
Endocrine Journal 06/2012; 59(9):797-807. · 2.03 Impact Factor
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Akihiro Sakurai,
Shinichi Suzuki,
Shinji Kosugi,
Takahiro Okamoto,
Shinya Uchino,
Akihiro Miya,
Tsuneo Imai,
Hiroshi Kaji,
Izumi Komoto,
Daishu Miura,
Masanobu Yamada, Takashi Uruno,
Kiyomi Horiuchi,
Akira Miyauchi,
Masayuki Imamura
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ABSTRACT: Objective Multiple endocrine neoplasia type 1 (MEN1) is less well recognized in Asian countries, including Japan, than in the West. The clinical features and optimal management of MEN1 have yet to be clarified in Japan. The aim of this study was to clarify the clinical features of Japanese patients with MEN1.Design/Patients We established a MEN study group designated the ‘MEN Consortium of Japan’ in 2008, and asked physicians and surgeons to provide clinical and genetic information on patients they had treated. Of 680 registered patients, 560 were analysed.Measurements Clinical and genetic features of Japanese patients with MEN1 were examined.Results Primary hyperparathyroidism, gastroenteropancreatic neuroendocrine tumours (GEPNET), and pituitary tumours were seen in 94·4%, 58·6% and 49·6% of patients, respectively. The prevalence of insulinoma was higher in the Japanese than in the West (22%vs 10%). In addition, 37% of patients with thymic carcinoids were women, while most were men in western countries. The MEN1 mutation positive rate was 91·7% in familial cases and only 49·3% in sporadic cases. Eight novel mutations were identified. Despite the availability of genetic testing for MEN1, the application of genetic testing, especially presymptomatic diagnosis for at-risk family members appeared to be insufficient.Conclusions We established the first extensive database for Asian patients with MEN1. Although the clinical features of Japanese patients were similar to those in western countries, there were several characteristic differences between them.
Clinical Endocrinology 03/2012; 76(4):533 - 539. · 3.17 Impact Factor
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Akihiro Sakurai,
Shinichi Suzuki,
Shinji Kosugi,
Takahiro Okamoto,
Shinya Uchino,
Akihiro Miya,
Tsuneo Imai,
Hiroshi Kaji,
Izumi Komoto,
Daishu Miura, [......],
Kazuyo Kiribayashi,
Shigeki Koizumi,
Sanae Midorikawa,
Rika Miyabe,
Takuya Munekage,
Atsushi Ozawa,
Kazuo Shimizu,
Iwao Sugitani,
Hiroshi Takeyama,
Masanori Yamazaki
[show abstract]
[hide abstract]
ABSTRACT: Multiple endocrine neoplasia type 1 (MEN1) is less well recognized in Asian countries, including Japan, than in the West. The clinical features and optimal management of MEN1 have yet to be clarified in Japan. The aim of this study was to clarify the clinical features of Japanese patients with MEN1.
We established a MEN study group designated the 'MEN Consortium of Japan' in 2008, and asked physicians and surgeons to provide clinical and genetic information on patients they had treated. Of 680 registered patients, 560 were analysed.
Clinical and genetic features of Japanese patients with MEN1 were examined.
Primary hyperparathyroidism, gastroenteropancreatic neuroendocrine tumours (GEPNET), and pituitary tumours were seen in 94·4%, 58·6% and 49·6% of patients, respectively. The prevalence of insulinoma was higher in the Japanese than in the West (22%vs 10%). In addition, 37% of patients with thymic carcinoids were women, while most were men in western countries. The MEN1 mutation positive rate was 91·7% in familial cases and only 49·3% in sporadic cases. Eight novel mutations were identified. Despite the availability of genetic testing for MEN1, the application of genetic testing, especially presymptomatic diagnosis for at-risk family members appeared to be insufficient.
We established the first extensive database for Asian patients with MEN1. Although the clinical features of Japanese patients were similar to those in western countries, there were several characteristic differences between them.
Clinical Endocrinology 09/2011; 76(4):533-9. · 3.17 Impact Factor
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ABSTRACT: Anaplastic thyroid carcinoma (ATC) has a very dire prognosis and no effective therapeutic strategies have been established for ATC patients, especially those with stage IVB or IVC. Our objective was to investigate the effectiveness of weekly paclitaxel administered as induction chemotherapy and to establish novel therapeutic strategies for ATC.
We performed induction chemotherapy by weekly paclitaxel administration for patients with stage IVB (nine patients) and IVC (four patients) disease. Clinical and histological responses were assessed. Overall survival was compared with that of ATC patients with stage IVB (n = 50) and IVC (n = 13) treated without paclitaxel.
One patient demonstrated complete response (CR) and two demonstrated partial response (PR) in the stage IVB group (response rate: 33%), and one patient showed PR in stage IVC (response rate: 25%). Curative surgery and adjuvant therapy were performed for four patients with stage IVB, and 32 months after treatment, all the four are alive and free of disease. One CR patient and one stable disease patient were assessed as grade IV (complete remission) and grade III (nearly CR) on histological response, respectively. All four patients with stage IVC died of carcinoma within 8 months. Overall survival of stage IVB patients with induction chemotherapy was better (p = 0.0213) than that without the chemotherapy and also better (p = 0.0467) than those with chemotherapy other than paclitaxel. However, induction chemotherapy did not improve the overall survival of stage IVC patients (p = 0.2002).
Induction chemotherapy by weekly paclitaxel is a promising therapeutic strategy for stage IVB ATC patients. Responders can be expected to achieve long-term survival. We could not get significant difference of overall survival between stage IVC patients with or without weekly induction paclitaxel, although there were some cases that responded well.
Thyroid: official journal of the American Thyroid Association 12/2009; 20(1):7-14. · 2.60 Impact Factor
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Yasuhiro Ito,
Mitsuhiro Fukushima,
Chisato Tomoda,
Hiroyuki Inoue,
Minoru Kihara,
Takuya Higashiyama, Takashi Uruno,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Akira Miyauchi
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ABSTRACT: Lymph node metastasis is an important clinicopathological feature of papillary thyroid carcinoma (PTC). PTC having clinically apparent lateral node metastasis detectable on preoperative imaging studies (N1b) is known to show a dire prognosis. However, N1b cases include various levels of biological aggressiveness, depending on the size, number, laterality and invasiveness of metastatic nodes. We investigated differences in the prognoses of 621 N1b patients based on these features and compared their prognoses with those of 4297 patients without clinically apparent metastasis (N0) and 125 patients with clinically apparent central node metastasis only (N1a). Disease-free survival (DFS) and cause-specific survival (CSS) of N1b or N1a patients were significantly worse than those of N0 patients, but the prognosis of N1b patients did not differ from that of N1a patients. In the subset of N1b patients, metastatic nodes larger than 3cm, extranodal extension, or 5 or more clinically apparent metastatic nodes independently affected DFS and a combination of the former two features also showed an effect on CSS on multivariate analysis. Prognosis of N1b patients who had none of these features did not differ from that of N1a patients. It is therefore suggested that N1b patients having metastasis larger than 3cm, those showing extranodal extension, and those having 5 or more clinically apparent metastasis should regarded as high-risk, and that careful surgical treatment and postoperative follow-up are necessary.
Endocrine Journal 07/2009; 56(6):759-66. · 2.03 Impact Factor
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Yasuhiro Ito,
Mitsuhiro Fukushima,
Tomonori Yabuta,
Chisato Tomoda,
Hiroyuki Inoue,
Minoru Kihara,
Takuya Higashiyama, Takashi Uruno,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Akira Miyauchi
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ABSTRACT: Since papillary thyroid carcinoma (PTC) with tracheal invasion shows a worse prognosis, aggressive surgical treatment including airway resection has been recommended. However, little is known about local recurrence of PTC with minimal tracheal invasion after shaving or laminated resection of the tracheal cartilage. In this study, we investigated the local prognosis of patients who were intra-operatively diagnosed as having minimal tracheal invasion.
Of 6,015 patients who underwent initial surgery for PTC between 1987 and 2004, 127 (2.1%) were intra-operatively suspected of having minimal invasion to the trachea and underwent shaving or laminated resection of the tracheal cartilage. These 127 patients were enrolled in this study.
Of 127 patients, 107 were intra-operatively regarded as having received macroscopically curative treatment (curative group), whereas minimal carcinoma remnants were suspected in the remaining 20 patients (suspicious group). To date, six patients (4.6%) (one patient in the curative group and five in the suspicious group) showed local recurrence at the tracheal edge. The local disease-free survival of patients in the curative group was better than that of those in the suspicious group (p = 0.0007), although the cause-specific survival of patients in the two groups did not differ. Cut surfaces of resected carcinoma were also pathologically examined for 119 patients and 58 (48.7%) were diagnosed as carcinoma-positive, but the cut surface status was not related to macroscopic curative treatment. Of six patients showing local recurrence, only one died of lung metastasis of carcinoma.
The incidence of local recurrence of PTC with minimal tracheal invasion is low at 4.6%. Although this event might not be immediately life-threatening for patients, to improve local prognosis, local curative treatment should be pursued. In cases that are suspected of persistent carcinoma remnants, further shaving or laminated dissection should be performed, and if the carcinoma remnant cannot be eliminated, tracheal fenestration should be considered, although such high-risk tumours may be likely to recur regardless of surgical radicality.
Asian Journal of Surgery 05/2009; 32(2):102-8. · 0.57 Impact Factor
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Yasuhiro Ito,
Takuya Higashiyama,
Mitsuyoshi Hirokawa,
Mitsuhiro Fukushima,
Hiroyuki Inoue,
Tomonori Yabuta,
Chisato Tomoda, Takashi Uruno,
Minoru Kihara,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Akira Miyauchi
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ABSTRACT: Anaplastic thyroid carcinoma arises from differentiated carcinoma and has a very aggressive character. In this study, we investigated the prognosis of patients with anaplastic carcinoma based on UICC stage.
We investigated the prognosis of 75 patients who were diagnosed as having anaplastic carcinoma at Kuma Hospital between 1983 and 2006. Of these patients, 14, 49 and 12 were classified into Stages IVA, IVB, and IVC respectively.
Stage IVA patients showed a significantly better prognosis than Stage IVB or IVC patients (p = 0.0017). All patients with Stage IVC died of carcinoma within 1 year regardless of whether locally complete resection was performed. Prognosis of Stage IVB patients who underwent curative surgery did not differ from that of Stage IVA patients, but the prognosis of those who did not undergo surgery or only received palliative surgery was as poor as that of Stage IVC patients.
Extensive surgical treatment is recommended for Stage IVA patients and palliative care is appropriate for Stage IVC patients. For Stage IVB patients, surgical treatment as a primary therapy is appropriate only when curative resection of the tumour is expected.
Asian Journal of Surgery 02/2009; 32(1):47-50. · 0.57 Impact Factor
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Yasuhiro Ito,
Kennichi Kakudo,
Mitsuyoshi Hirokawa,
Mitsuhiro Fukushima,
Tomonori Yabuta,
Chisato Tomoda,
Hiroyuki Inoue,
Minoru Kihara,
Takuya Higashiyama, Takashi Uruno,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Akira Miyauchi
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ABSTRACT: Although the responsible genes have not yet been identified, it is known that the risk of nonmedullary thyroid carcinoma is elevated in individuals with 1st-degree relatives with nonmedullary thyroid carcinoma. However, it remains controversial whether the biological character of familial nonmedullary carcinoma (FNMTC) differs from that of sporadic carcinoma. In this study, we investigated the prevalence of familial papillary carcinoma and its biological behavior.
Between 1987 and 2004, 6,015 patients underwent initial surgical treatment for papillary carcinoma at Kuma Hospital and 273 (4.5%) were classified as having familial carcinoma. We compared the biological characteristics including prognosis between familial and sporadic papillary carcinomas.
Disease-free survival and cause-specific survival rates of familial carcinoma did not differ from those of sporadic carcinoma. Familial papillary carcinoma showed multicentricity and recurrence to the thyroid more frequently than sporadic carcinoma. There were no differences in other clinicopathological parameters between the 2 groups.
Prognosis of patients with familial papillary carcinoma did not differ from that of those with sporadic papillary carcinoma. Although routine total thyroidectomy is recommended for familial papillary carcinoma, its therapeutic strategy can otherwise be the same as that for sporadic papillary carcinoma.
Surgery 02/2009; 145(1):100-5. · 3.10 Impact Factor
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Tomonori Yabuta,
Yasuhiro Ito,
Mitsuyoshi Hirokawa,
Mitsuhiro Fukushima,
Hiroyuki Inoue,
Chisato Tomoda,
Takuya Higashiyama,
Minoru Kihara, Takashi Uruno,
Yuuki Takamura,
Kaoru Kobayashi,
Akihiro Miya,
Fumio Matsuzuka,
Akira Miyauchi
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ABSTRACT: Preoperative excess iodide administration for patients with Graves' disease has been widely adopted by surgeons to perform surgery safely, because it decreases blood flow in the thyroid. However, surgeons often encounter the enlargement of thyroid volume after iodide administration, which makes surgery even more difficult. In this study, we retrospectively investigated the change in thyroid volume in Graves' disease that was evaluated on ultrasonography between before and after iodide administration. Eighty-nine patients who received iodide administered (KI(+) patients) and 24 in whom iodide was not administrated (KI(-) patients) before surgery for Graves' disease were enrolled in the study. The level of free T4 (FT4) significantly decreased and that of thyroid stimulating hormone (TSH) significantly increased after iodide administration. Average thyroid volume also significantly increased for KI(+) patients after iodide administration and 17% of these patients showed a 30% or more increase in thyroid volume. In KI(-) patients who were preoperatively treated only by anti-thyroid drugs, thyroid volume did not change before surgery. Preoperative TSH levels remained below measurement sensitivity in 37 of KI(+) patients, but the average thyroid volume also significantly increased after iodide administration. These findings suggest that thyroid volume in Graves' disease can increase with iodide administration not only due to TSH stimulation but also due to reasons other than TSH. Surgeons should be careful when preoperatively iodide administering to patients with Graves' disease, especially when the goiter is large.
Endocrine Journal 02/2009; 56(3):371-5. · 2.03 Impact Factor
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Yasuhiro Ito,
Akira Miyauchi,
Tomonori Yabuta,
Mitsuhiro Fukushima,
Hiroyuki Inoue,
Chisato Tomoda, Takashi Uruno,
Minoru Kihara,
Takuya Higashiyama,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka
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ABSTRACT: Medullary thyroid carcinoma (MTC) accounts only for 1.4% of all thyroid malignancies in Japan. Since 1996, we have performed hemithyroidectomy, instead of total thyroidectomy, for sporadic nonhereditary MTC when the primary lesion is located in only one lobe. Regarding lymph node dissection, modified radical neck dissection (MND) at least ipsilateral to the tumor has been routinely performed, even if there is no clinically apparent metastasis. We investigated the clinical outcomes of MTC patients in our department.
A series of 118 patients with MTC who underwent initial surgery between 1975 and 2005 were enrolled in this study. The RET gene mutations were analyzed for all patients and 46 had germline RET gene mutations. Of those 46 patients, 26 were diagnosed as MEN 2A and 2 were diagnosed as MEN 2B. Postoperative follow-up periods averaged 141 months.
Of 115 patients who did not have distant metastasis at surgery and who underwent locally curative surgery, 78 (67.8%) were biochemically cured. All patients without pathological lymph node metastasis were biochemically cured, and 44.8% of patients with node metastasis were also biochemically cured. The 10-year and 20-year disease-free survival rates were 89.0% and 82.5%, respectively. None of the patients who did not show lymph node metastasis and only 2 (2.6%) of 78 patients who were biochemically cured showed clinically apparent carcinoma recurrence. The 10-year and 20-year cause-specific survival rates were 96.6% and 91.7%, respectively. Lymph node metastasis, tumor size>4 cm, extrathyroid and extranodal tumor extensions significantly affected cause-specific survival of patients.
Clinical outcomes of MTC patients in our series were better than those in Western countries, a result that might have resulted in part because of our routine MND regardless of whether clinically apparent node metastasis was detected.
World Journal of Surgery 12/2008; 33(1):58-66. · 2.36 Impact Factor
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Yasuhiro Ito,
Kennichi Kakudo,
Mitsuyoshi Hirokawa,
Mitsuhiro Fukushima,
Chisato Tomoda,
Hiroyuki Inoue,
Minoru Kihara,
Takuya Higashiyama, Takashi Uruno,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Akira Miyauchi
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ABSTRACT: Extrathyroid extension is a prominent prognostic factor of papillary thyroid carcinoma (PTC). In the UICC TNM classification, minimal extension to the sternothyroid muscle and perithyroid soft tissue is classified as T3 and further massive extension is classified as T4, the highest T grade. However, there have been few studies on the clinical significance of extension to the parathyroid gland in a large case series. In this study, we investigated the prognosis of PTC with extension to the parathyroid gland in a series of 3208 patients who underwent initial surgery between 1997 and 2004. Of these patients, 51 (1.6%) showed extension to the parathyroid gland on pathological examination. Twenty-one of these patients had massive extrathyroid extension to other adjacent organs corresponding to pT4. The remaining 30 were enrolled in this study. The disease-free survival (DFS) of these 30 patients was significantly better (p<0.0001) than that of pT4 patients and did not differ from that of patients showing minimal extrathyroid extension without extension to the parathyroid gland (p = 0.6264). Furthermore, none of these 30 patients died of carcinoma. Taken together, it is appropriate that extension to the parathyroid gland of PTC is graded as minimal extrathyroid extension (pT3), but not massive extension (pT4). Since minimal extension did not affect patient prognosis in our series, it is suggested that extension to the parathyroid gland has little clinical significance in PTC.
Endocrine Journal 12/2008; 56(2):251-5. · 2.03 Impact Factor
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ABSTRACT: There are many variants of papillary carcinoma, and some of these variants have been reported to show biological behaviours differing from that of conventional papillary carcinoma. In this study, we present our experience regarding the prevalence and prognoses of these variants of papillary carcinoma.
H&E sections from 1521 patients who underwent initial surgery for papillary carcinoma in Kuma Hospital between 1987 and 1995 were re-reviewed and classified into conventional papillary carcinoma and various histological variants. We investigated the biological behaviours of these lesions, including prognoses.
Follicular, tall cell and oncocytic variants were observed in comparably high incidences: 6.6%, 3.9%, and 1.9%, respectively. Patients with tall cell variant showed significantly worse disease-free survival (DFS) and cause-specific survival (CSS) rates than those with conventional papillary carcinoma. The prognoses of patients with follicular variant did not differ from those of patients with conventional papillary carcinoma. Patients with oncocytic variant have not shown carcinoma recurrence. Among the rare variants, which accounted for less than 1%, columnar cell carcinoma showed a worse prognosis.
Since patients with some variants show different clinical outcomes from those with conventional papillary carcinoma, classification of variants might be helpful to predict patient prognosis.
Pathology 11/2008; 40(6):617-22. · 2.38 Impact Factor
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Yasuhiro Ito,
Hiroshi Yoshida,
Rie Maruo,
Shinji Morita,
Toru Takano,
Mitsuyoshi Hirokawa,
Tomonori Yabuta,
Mitsuhiro Fukushima,
Hiroyuki Inoue,
Chisato Tomoda,
Minoru Kihara, Takashi Uruno,
Takuya Higashiyama,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Akira Miyauchi
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ABSTRACT: Recent studies have demonstrated that BRAF(V600E) mutation is a common event in papillary thyroid carcinoma and a majority of these lesions have shown a direct relationship between BRAF(V600E) mutation and aggressive characteristics, including a worse patient prognosis. However, there are no studies from Japan regarding this issue in a large series with adequate postoperative follow-up periods. We investigated BRAF(V600E) mutation in 631 patients with papillary carcinoma having median follow-up periods of 83 months. The prevalence of BRAF(V600E) mutation was 38.4%, and the rate was higher in carcinoma larger than 1.0 cm but did not successively increase with tumor size. Furthermore, the prevalence did not significantly increase in cases demonstrating high-risk biological features such as clinically apparent lymph node metastasis, massive extrathyroid extension, advanced age, distant metastasis at surgery, and advanced Stage. The disease-free survival of patients with BRAF(V600E) mutation did not differ from that of those without BRAF(V600E) mutation. These findings indicate that, although BRAF(V600E) mutation may play some roles in local carcinoma development, there is no evidence that BRAF(V600E) mutation significantly reflects the aggressive characteristics and poor prognosis of patients with papillary carcinoma in Japan.
Endocrine Journal 11/2008; 56(1):89-97. · 2.03 Impact Factor
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Yasuhiro Ito,
Takuya Higashiyama,
Mitsuyoshi Hirokawa,
Mitsuhiro Fukushima,
Hiroyuki Inoue,
Tomonori Yabuta,
Chisato Tomoda, Takashi Uruno,
Minoru Kihara,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Akira Miyauchi
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ABSTRACT: Anaplastic carcinoma arises from differentiated carcinoma and generally shows a dire prognosis. Anaplastic transformation may occur not only in primary tumors but also in metastatic lymph nodes. We encountered 5 cases of papillary carcinoma showing anaplastic transformation in lymph nodes that were curatively resected. Patient ages ranged from 67 to 85 years. Two of these patients showed anaplastic transformation at the initial surgery and the remaining 3 showed anaplastic transformation after repeated recurrence to the lymph nodes. After resection of anaplastic lesions of the nodes, 2 patients underwent radiation therapy, whereas the remaining 3 did not receive any adjuvant therapy. One patient died of rapid growth of lung metastasis 5 months after the resection. One patient died of carcinoma 63 months after surgery. Two patients have survived to date, 6 and 85 months after resection, respectively. The remaining one patient died of heart failure 11 months after surgery. It is therefore suggested that long-term survival can be expected for patients with differentiated carcinoma showing anaplastic transformation in the lymph node if the lesions can be curatively resected.
Endocrine Journal 08/2008; 55(6):985-9. · 2.03 Impact Factor
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Yasuhiro Ito,
Mitsuyoshi Hirokawa,
Mitsuhiro Fukushima,
Hiroyuki Inoue,
Tomonori Yabuta, Takashi Uruno,
Minoru Kihara,
Takuya Higashiyama,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Akira Miyauchi
[show abstract]
[hide abstract]
ABSTRACT: Papillary carcinoma with clinically apparent node metastasis but lacking a primary carcinoma lesion in the thyroid is designated as occult papillary carcinoma. In the era of routine ultrasonographic examination, occult papillary carcinoma is defined as papillary carcinoma with clinically apparent node metastasis but showing a primary lesion that is microscopic or overlooked by ultrasonography. In this study we investigated the prevalence and clinicopathologic features, including prognosis, of occult papillary carcinoma.
This is a retrospective series study of all patients with occult papillary thyroid carcinoma who underwent initial surgery at a single institution over 14 years.
Between 1990 and 2004, 5400 patients underwent surgery for papillary thyroid carcinoma at Kuma Hospital, Japan. Seventeen (0.3%) were regarded as having occult papillary carcinoma and were enrolled in the study. Clinically apparent node metastasis was detected in the lateral compartment in 16 patients and in the mediastinal compartment in 1 patient. Multiple metastatic nodes were detected in 5 patients (29%). Primary lesions of papillary carcinoma were intraoperatively detected in 3 of 14 patients (21%) who underwent thyroidectomy, but there were no apparent carcinoma lesions in the thyroid in 5 patients (36%), even on pathologic examination. Six patients (35%) showed extranodal tumor extension to adjacent organs and two of these patients showed recurrence. None of the patients showed distant metastasis or died of carcinoma over the study period.
Patients with occult papillary thyroid carcinoma were found to have a favorable overall prognosis. However, occult papillary carcinoma is automatically classified as N1b in the UICC classification, and in our series it is also likely to show other aggressive clinicopathologic features. In particular, extranodal tumor extension portends a worse prognosis for patients with occult papillary carcinoma. Therefore, careful total thyroidectomy with lymph node dissection is recommended except for elderly or high-risk patients.
World Journal of Surgery 08/2008; 32(9):1955-60. · 2.36 Impact Factor
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Yasuhiro Ito,
Mitsuyoshi Hirokawa,
Mitsuhiro Fukushima,
Hiroyuki Inoue,
Tomonori Yabuta, Takashi Uruno,
Minoru Kihara,
Takuya Higashiyama,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Akira Miyauchi
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ABSTRACT: In the 1980s, histology of a poorly differentiated carcinoma showing an aggressive behavior was proposed by Sakamoto et al. and other pathologists. This was adopted as an independent entity by the World Health Organization (WHO) and in the General Rules for the Description of Thyroid Cancer by The Japanese Society of Thyroid Surgery (JSTS). Furthermore, the Turin classification was recently proposed as the newest classification system for poorly differentiated carcinoma. Furthermore, although tall cell variant is not included in poorly differentiated carcinoma, it is thought to show aggressive characteristics. In this study, we investigated the prevalence and clinical significance of three types of poorly differentiated carcinoma defined by the WHO classification system (poorly differentiated carcinoma [WHO]), Turin proposal (poorly differentiated carcinoma [Turin]), and JSTS (poorly differentiated carcinoma [Sakamoto]), and tall cell variant in papillary carcinoma.
We investigated the prevalence and prognostic significance of these three histological types in 1707 papillary carcinomas.
In our series, 189 (11.1%), 15 (0.8%), 5 (0.3%), and 62 (3.6%) patients were diagnosed as having poorly differentiated carcinoma (Sakamoto), poorly differentiated carcinoma (WHO), poorly differentiated carcinoma (Turin), and tall cell variant, respectively. Poorly differentiated carcinoma (WHO) and tall cell variant independently affected cause-specific survival (CSS) of patients, but poorly differentiated carcinoma (Sakamoto) predicted only worse disease-free survival (DFS) of patients on multivariate analysis. Poorly differentiated carcinoma (Turin) showed the worst DFS and CSS rates of patients but was not confirmed as an independent prognostic factor probably because of the small number of patients.
Poorly differentiated carcinoma (WHO) and tall cell variant significantly affected patient prognosis. Poorly differentiated carcinoma (Turin) accounts only for 0.3% but showed the worst survival rates. Although poorly differentiated carcinoma (Sakamoto) predicted the likelihood of carcinoma recurrence, it is more appropriate to define this lesion as one of the histological subtypes of papillary carcinoma rather than as an independent histological entity.
World Journal of Surgery 08/2008; 32(7):1535-43; discussion 1544-5. · 2.36 Impact Factor
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Yasuhiro Ito,
Tomonori Yabuta,
Mitsuyoshi Hirokawa,
Mitsuhiro Fukushima,
Hiroyuki Inoue, Takashi Uruno,
Minoru Kihara,
Takuya Higashiyama,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Nobuyuki Amino,
Akira Miyauchi
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[hide abstract]
ABSTRACT: Among thyroid nodules arising from follicular cells, benign nodular goiter is thought not to metastasize to regional or distant organs. However, we encountered five cases that were pathologically diagnosed as benign nodular goiter but showed metastasis. The prevalence of benign nodular goiter showing metastasis was 0.17% (5 of 2978 patients). On pathology, there were no detectable signs of carcinoma or follicular adenoma lesions. Two patients showed lymph node metastasis that was pathologically confirmed as metastasis of nodular goiter. One was preoperatively and another was postoperatively detected by ultrasonography. These patients also showed distant metastases that could be ablated by radioiodine. One patient preoperatively showed lung metastasis and the remaining two showed lung and bone metastases and bone metastasis postoperatively. Pathological diagnosis of thyroid nodules has limitations, and cases diagnosed as benign nodular goiter should still undergo careful follow-up.
Endocrine Journal 07/2008; 55(5):889-94. · 2.03 Impact Factor
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Yasuhiro Ito,
Mitsuhiro Fukushima,
Tomonori Yabuta,
Hiroyuki Inoue, Takashi Uruno,
Minoru Kihara,
Takuya Higashiyama,
Yuuki Takamura,
Akihiro Miya,
Kaoru Kobayashi,
Fumio Matsuzuka,
Akira Miyauchi
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ABSTRACT: Although the responsible gene has not yet been identified, patients with differentiated thyroid carcinoma, including papillary and follicular carcinomas, demonstrating a family history have been reported and patients having one or more family members with differentiated carcinoma among their first-degree relatives are designated as having familial nonmedullary thyroid carcinoma (FNMTC). In this study, we investigated the biological characteristics, including prognosis, of familial follicular carcinoma. Three hundred and nineteen patients who underwent initial surgery for follicular thyroid carcinoma between 1987 and 2004 who were enrolled in this study. Of these 319 patients, 6 patients (1.9%) in 6 families were classified as having familial follicular carcinoma based on the criteria described above. The incidence of aggressive characteristics such as male gender, age 45 years or older, poor differentiation, widely invasive carcinoma, tumor larger than 4 cm and distant metastasis at diagnosis did not differ between familial and sporadic follicular carcinomas. One patient with familial follicular carcinoma underwent re-operation because of newly detected papillary carcinoma in the remnant thyroid 160 months after the initial surgery, but none of the 6 patients with familial carcinoma showed recurrence or died of follicular carcinoma. We can therefore conclude that FMNTC of the follicular type is very rare and there is no evidence that familial follicular carcinoma is more aggressive or has a worse prognosis than sporadic follicular carcinoma. The therapeutic strategy for follicular carcinoma might depend on conventional prognostic factors such as poor differentiation and distant metastasis at diagnosis, but not on whether the carcinoma is familial or sporadic.
Endocrine Journal 06/2008; 55(5):847-52. · 2.03 Impact Factor
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ABSTRACT: A subtype of papillary thyroid carcinoma that is totally surrounded by a fibrous capsule is designated an encapsulated carcinoma. In this study, we investigated the biologic behavior and prognosis of this type of carcinoma.
The clinicopathologic parameters and prognosis were compared between 1207 patients with conventional papillary carcinoma and 149 patients diagnosed as having encapsulated papillary carcinoma who underwent initial surgery between 1987 and 1996.
Sex, age, and the tumor size of the encapsulated carcinoma did not differ from those of patients with conventional papillary carcinoma. However, none of the patients with encapsulated carcinoma showed distant metastasis at diagnosis. The incidences of pathologic lymph node metastasis and clinically apparent lateral node metastasis in patients with encapsulated carcinomas were significantly lower than in those with a conventional papillary carcinoma. Ten patients (6.7%) with encapsulated carcinoma showed recurrence after surgery. After excluding recurrence to the remnant thyroid, disease-free survival of patients with encapsulated carcinoma was significantly better than that of those with conventional papillary carcinoma. None of the patients with encapsulated carcinoma died of carcinoma.
Encapsulated papillary carcinoma exhibits a more indolent biologic behavior than conventional papillary carcinoma. However, because recurrence to locoregional and even distant organs can be seen, careful and constant postoperative follow-up is recommended.
World Journal of Surgery 04/2008; 32(8):1789-94. · 2.36 Impact Factor
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ABSTRACT: The relative expression level of trefoil factor 3 (TFF3) mRNA to galectin-3 (LGALS3) mRNA (T/G ratio) is a useful marker to distinguish thyroid follicular carcinomas from adenomas. However, because of the interference by the simultaneously aspirated peripheral blood cells or infiltrating lymphocytes, the precise measurement of the T/G ratio in aspirates is difficult.
We tested 2 methods of selecting thyroid tumor cells and removing blood cells from the aspirates. One method was selection with magnetic beads coated with Ber-EP4 antibody and the other was filtration through a nylon mesh.
After selection with Ber-EP4 antibody, T/G ratios in aspirates showed varied degrees of difference from those in the corresponding tissues. After mesh filtration, differences in T/G ratios between the aspirates and the corresponding tissues were less than 200% in all 8 cases.
Mesh filtration of aspirates proved superior results for the measurement of T/G ratio.
Head & Neck 03/2008; 30(8):983-90. · 2.40 Impact Factor
